初治单用阿德福韦酯与拉米夫定治疗慢性乙型肝炎应答不佳时加用阿德福韦酯的疗效比较

目的比较初始单用阿德福韦酯与拉米夫定疗效不佳时加用阿德福韦酯在慢乙肝患者中抗病毒治疗效果,从而了解拉米夫定是否影响阿德福韦酯的药效。方法采用回顾性分析方法,把136例乙肝患者按照用药情况分成两组。A组为初始使用阿德福韦酯,B组为初始使用拉米夫定疗效不佳后加用阿德福韦酯(10 mg/d)。分别在治疗12周、24周和48周采血,检测各组血清ALT、乙肝五项、HBV DNA变化。结果治疗12周、24周和48周时A组和B组病毒学应答率分别为51.9%和59.5%,63.0%和65.0%,71.2%和88.9%,P值分别为0.446、0.870和0.218;生化学应答率分别为41.4%和44.9%,53.4%和70.0%,65.2%和77.8%,P值分别为0.690、0.185和0.309;E抗原阴转率分别为38.9%和18.5%,56.0%和43.8%,70.8%和50.0%,P值分别为0.064、0.393、0.304;E抗原血清转换的比例分别28.7%和14.8%,40.0%和25.0%,45.8%和33.3%,P值分别为0.194、0.287和0.434。治疗12周、24周、48周时A组和B组在病毒学应答率、生化学应答率、E抗原阴转率和E抗原血清转换方面差异均无统计学意义。结论对于初治采用拉米夫定效果不佳的慢性乙型肝炎患者,拉米夫定的使用并不影响后期加用阿德福韦酯的疗效。

Efficacy comparison of Initial treatment with adefovir and lamivudine in treating chronic hepatitis B poor response of plus adefovir

Objective To compare the antivirus treatments efficacy of the initially single-use of the adefovir(ADV) with the adefovir adjunctive therapy in the case of the poor response of lamivudine(LAM) on the patients with chronic hepatitis B,and then to find out whether the pre-use of lamivudine will affect the antivirus treatment efficacy of adefovir dipivoxil.Methods All 136 cases of hepatitis B patients were reviewed retrospectively.These cases were divided into two categories in term of drug-use: A group was treated with single-using ADV initally;B group using the ADV adjunctive therapy in the case of the poor treatments of LAM(10mg/d).The efficacy was assessed by monitoring the serum ALT,HBeAg and HBV DNA change after 12,24 and 48 weeks of therapy.Results After 12,24 and 48 weeks of therapy,the virologic response rates of A and B group were 51.9% and 59.5%,63.0% and 65.0%,71.2% and 88.9%,and the P values were 0.446,0.870 and 0.218,respectively;biochemical response rates were 41.4% and 44.9%,53.4% and 70.0%,65.2% and 77.8%,and the P values were 0.690,0.185 and 0.309,respectively;E antigen-negative conversion rates were 38.9% and 18.5%,56.0% and 43.8%,70.8% and 50.0%,and the P values were 0.064,0.393 and 0.304,respectively;E antigen seroconversion rates were 28.7% and 14.8%,40.0% and 25.0%,45.8% and 33.3%,and the P values were 0.194,0.287 and 0.434,respectively.The statistic results indicated there was no statistically significant difference between two cases in virological response,biochemical response rate,e antigen-negative rate and E antigen seroconversion after 12,24 and 48 weeks of treatments.Conclusion For the initially lamivudine treated patients with chronic hepatitis B who has a poor response to LAM,the pre-use of lamivudine has no affection on the antivirus treatment efficacy of the adjunctive adefovir.