阿德福韦酯单药及其联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎的疗效比较

目的比较阿德福韦酯（ADV）单药及其联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎（chronic hepatitis B，CHB）的临床疗效。方法对24例ADV单药及28例ADV联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎患者的疗效进行回顾性分析，比较两组患者HBVDNA、ALT水平及HBV DNA检测不到率、ALT复常率的差异。结果两组患者的性别、年龄、治疗前的HBV DNA及ALT水平差异均无统计学意义。两组的HBV DNA、ALT水平在治疗48周、72周时分别与同组治疗前比较均有明显降低（P〈0．05）。治疗48周时，联合组的HBV DNA检测不到率虽高于单药组，但差异无统计学意义（50％vs25％，P〉0．05）；ALT复常率两组间无明显差别（67．9％vs75％，P〉0．05）。治疗72周时，联合组的HBV DNA检测不到率为68％，要显著高于单药组的33．3％（P〈0．05）；联合组的ALT复常率为93％，显著高于单药组的70．8％（P〈0．05）。结论ADV单药或联合拉米夫定均是治疗拉米夫定耐药HBeAg阳性CHB的有效方法，联合治疗的疗效要优于单药治疗。

A Comparative Study on the Efficacy of ADV Monotherapy and in Combination with Lamivudine in the Treatment of Lamivudine-resistant HBeAg Positive Chronic Hepatitis B

Objective To evaluate the efficacy of adefovir dipivoxil （ADV） monotherapy and in combination with lamivudine in the treatment of lamivudine-resistant HBeAg positive chronic hepatitis B （CHB）. Methods A total of fifty two cases of lamivudine-resistant HBeAg positive CHB treated with ADV monotherapy （24 cases） or in combination with lamivudine （28 cases ） were analyzed retrospectively. Differences in HBV DNA, ALT level, negative rate of HBV DNA and ALT recovery rate were determined. Results Before the treatment, there was no significant difference between the two groups in gender, age, HBV DNA and ALT level. At week-48 and week-72 after the treatment, the level of ALT and HBV DNA was significantly reduced （P〈0.05）. The negative HBV DNA detection rate in the combined treatment group （50%） was not significantly different （P〉0.05） from the monotherapy group （25%）. ALT recovery rate at week-48 was similar in these two groups（67.9% versus 75% ,P〉0.05）. At week-72, the negative HBV DNA detection rate was 68% in the combined treatment group and the result was significantly higher than the monotherapy group （33.3%,P〈0.05）. The ALT recovery rate （93%） in the combined treatment group was significantly higher than the monotherapy group （70.8% ,P〈0.05）.Conclusion ADV monotherapy or in combination with lamivudine is effective in the treatment of lamivudine-resistant HBeAg positive CHB.The overall efficacy of combination therapy is better than the monothrapy.