慢性乙型肝炎救援治疗疗效不佳的四种后续治疗方案探讨

目的探讨慢性乙型肝炎患者救援治疗失败后4种后续治疗（阿德福韦酯、加大阿德福韦酯剂量、改用恩替卡韦、加用恩替卡韦）的临床疗效。方法将44例阿德福韦酯救援治疗失败的拉米夫定耐药患者随机分为A、B、C、D4组,分别给予阿德福韦酯（10mg,1次/d）、阿德福韦酯（15mg,1次/d）、恩替卡韦（1mg,1次/d）、阿德福韦酯（10mg,1次/d）＋恩替卡韦（1mg,1次/d）进行后续抗病毒治疗,观察4组HBVDNA转阴率、HBeAg转阴率和ALT复常率。结果 A组、B组、D组HBVDNA转阴及ALT的复常均取得了较好的疗效,C组的HBVDNA转阴及ALT的复常均未取得较好的疗效。结论对于拉米夫定耐药患者在给予24周的阿德福韦酯的救援治疗后,尚未取得良好疗效,采用继续原方案治疗、调整阿德福韦酯剂量及阿德福韦酯和恩替卡韦联合等方式进行后续治疗均可,其中前两个方案以阿德福韦酯疗效加强为目的进行治疗,后一方案为目前所提倡的联合治疗。

Exploration of clinical effects on chronic hepatitis B patients with follow-up care after rescue treatment failure

Objective To explore the clinical effects on chronic hepatitis B patients with four follow-up care（adefovir dipivoxil,increase the dose of adefovir dipivoxil,entecavir use,plus entecavir） after rescue treatment failure.Methods 44 cases of rescue treatment failure using adefovir dipivoxil after lamivudine resistant were randomized into A,B,C,D four groups and used adefovir dipivoxie（10mg,once a day）,adefovir dipivoxil（15mg,once a day）,entecavir（1mg,once a day）,adefovir dipivoxil（10mg,once aday） ＋entecavir（1mg,once a day） for subsequent anti-viral treatment.Results HBV DNA of group A,B and D were negative,and ALT normalization of group A,B and C were achieved good effects,HBV DNA of group C was negative and normalization of group C were not made better results.Conclusion For patients with lamivudine resistant to give 24 weeks of adefovir dipivoxil rescue therapy,efficacy has not made good by to the original regimen,adjusting the dose of adefovir dipivoxil and adefovir dipivoxil and entecavir therapy combined follow-up care of which the first two programs to strengthen the efficacy of adefovir dipivoxil treatment for the purpose,the latter advocated for the current combination therapy.