阿德福韦酯应答不佳的慢性乙型肝炎患者加用恩替卡韦进行优化治疗的临床研究

目的分析阿德福韦酯应答不佳的E抗原（HBeAg）阳性慢性乙型肝炎患者加用恩替卡韦进行联合治疗的疗效。方法阿德福韦酯治疗1年而乙型肝炎病毒脱氧核糖核酸（HBV DNA）仍阳性的慢性乙型肝炎患者被纳入,采用阿德福韦酯联合恩替卡韦治疗作为优化治疗策略。结果共纳入25例患者,本组患者在治疗3个月和6个月时均取得了较好的应答率;在联合治疗开始后的第3个月和第6个月,HBV DNA阴转率分别达到64%（16/25）和92%（23/25）,丙氨酸氨基转移酶（ALT）复常率分别达到72%（18/25）和96%（24/25）,HBeAg消失率分别是8%（2/25）和24%（6/25）,HBeAg/Anti-HBe血清学转换率分别是4%（1/25）和12%（3/25）。在头6个月的联合治疗期内,患者耐受良好,所有患者均未发生任何严重不良事件。结论阿德福韦酯应答不佳的慢性乙型肝炎患者,采用恩替卡韦联合阿德福韦酯进行优化治疗可获得较好的疗效。

Clinical study of Entecavir and Adefovir combination in optimization of HBeAg-positive chronic hepatitis B patients with poor response to Adefovir

Objective To evaluate the efficacy of Entecavir（ETV） and Adefovir（ADV） combination therapy in patients with hepatitis B e antigen（HBeAg） positive chronic hepatitis B（CHB） and poor response to ADV monotherapy.Methods CHB patients with detectable HBV DNA after 1 year of ADV monotherapy were included and received ETV plus ADV for more than 6 months.Results A total of 25 patients were included.Patients with ETV plus ADV had an improved response rate at both 3 months and 6 months.The rate of HBV DNA negativity（HBV DNA level 1 000 copies/mL） was 64%（16/25） and 92%（23/25） at 3 months and 6 months respectively;the alanine aminotransferase（ALT） normalization rate was 72%（18/25） and 96%（24/25） respectively;the HBeAg loss rate was 8%（2/25） and 24%（6/25） respectively;and HBeAg seroconversion rate was 4%（1/25） and 12%（3/25） respectively.During the first 6 months of combination therapy,all patients were well tolerated and no adverse reactions were reported.Conclusion CHB patients who are poor response to ADV monotherapy obtain more benefits from the combination of ETV and ADV.