阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎疗效观察

目的观察单用阿德福韦酯与阿德福韦酯联合拉米夫定在治疗耐药慢性乙型肝炎的临床疗效及安全性差异。方法将2006年1月至2008年1月我院门诊及住院符合入选标准的64例拉米夫定耐药的慢性乙型肝炎患者随机分为观察组与对照组,在常规治疗基础上,观察组给予阿德福韦酯联合拉米夫定治疗,对照组单用阿德福韦酯治疗,观察期为72周,观测血清HBV DNA水平、HBV血清学标志、肝功能变化及不良反应。结果在治疗48周时,观察组HBV DNA阴转率为68.8%（22/32）,对照组HBV DNA阴转率为34.4%（11/32）,2组差异有统计学意义（χ2=7.570,P〈0.01）,观察组患者HBeAg/抗HBe转换率为28.1%（8/32）,对照组患者HBeAg/抗HBe转换率为6.25%（2/32）,2组差异有统计学意义（χ2=5.379,P〈0.05）,观察组患者丙氨酸氨基转移酶（ALT）复常率为71.9%（23/32）,对照组患者ALT复常率为34.4%（11/32）,2组差异有统计学意义（χ2=9.035,P〈0.01）。结论阿德福韦酯联合拉米夫定较单用阿德福韦酯治疗拉米夫定耐药性慢性乙型肝炎有更好的疗效,值得应用。

Clinical observation on adefovir dipivoxil in the treatment of 64 patients with lamivudine-resistant chronic hepatitis B

Objective To observe the therapeutic effect of the single-use adefovir dipivoxil and adefovir dipivoxil combined with lamivudine （LAM） on patients with lamivudine-resistant chronic hepatitis B.Methods 64 patients with lamivudine-resistant chronic hepatitis B admitted from January 2006 to January 2008 in our hospital including out-patients and in-patients were randomly divided into observation group and control group.The patients in observation group,on the basis of routine treatment,were treated by adefovir dipivoxil combined with lamivudine,however,the patients in control group were treated by adefovir dipivoxil only for 72 weeks in both groups.The serum HBV DNA levels,HBV serum markers,liver functional changes and adverse reactions were observed.Results At 48 weeks after treatment,the HBV DNA negative conversion rate in observation group was 68.8% （22/32）,which was 34.4% （11/32） in control group,and there was a significant difference between the two groups （P〈0.01）.The HBeAg/anti-HBe conversion rate in observation group was 28.1% （8/32）,which was 6.25% （2/32） in control group,and there was a significant difference between the two groups （P〈0.05）.The ALT normalization rate in observation group was 71.9% （23/32）,which was 34.4% （11/32） in control group,and there was a significant difference between the two groups （P〈0.01）.Conclusion The adefovir dipivoxil combined with lamivudine is superior to lamivudine only in the treatment of lamivudine-resistant chronic hepatitis B,which is worthy of application in clinic.