干扰素和阿德福韦序贯治疗慢性乙型肝炎的临床分析

目的 评价阿德福韦治疗经IFN-α治疗12周无应答的慢性乙型肝炎患者的疗效和安全性.方法 36例经IFN-α治疗12周,复查HBeAg仍阳性且HBV DNA＞5log10拷贝/mL的患者,按随机双盲的方法,分为治疗组和对照组各18例.治疗组给予阿德福韦,对照组继续给予IFN-α,治疗52周.结果 治疗52周末,治疗组与对照组HBV DNA载量比较差异有统计学意义(χ2=3.04,P＜0.01);HBV DNA载量下降超过2 log10拷贝/mL的患者比较,两组差异有统计学意义(χ2=11.10,P＜0.01).治疗组HBeAg阴转率为22.22%,HBeAg/抗-HBe血清转换率为11.11%,与对照组的27.78%和16.67%相比,差异均无统计学意义.治疗组ALT复常率为88.89%,对照组为61.11%(P＜0.05).HBV DNA＜5log10拷贝/mL的患者停药24周反跳率治疗组为25.00%,对照组为16.67%.结论 继以阿德福韦序贯治疗经IFN-α治疗12周无应答的慢性乙型肝炎患者,能有效抑制其病毒复制,但HBeAg/抗-HBe的血清转换率变化不明显.试验52周内阿德福韦使用安全且耐受性良好,但阿德福韦的治疗终点仍有待研究.

Clinical analysis of interferon-alfa and adefovir sequential treatment for chronic hepatitis B

Objective To evaluate the efficacy and safety of adefovir (ADV) in the treatment of chronic hepatitis B patients with no response to 12 weeks treatment of interferon-α. Methods After 12 weeks treatment of interferon-α, 36chronic hepatitis B patients with HBeAg positive or HBV DNA ＞ 5log10 copies/mL were randomly assigned as treatment group and control group. 18 patients in treatment group were accepted ADV, and other 18 patients in control group continued to accept intefferon-α for 52 weeks. Results At the end of 52 weeks, HBV DNA levels in treatment group reduced obviously compared to control group( χ2 = 3.04, P ＜ 0.01 ); the ratio of patients whose HBV DNA levels reduced above 2 log in treatment group was also obviously compared to control group( χ2 = 11.10, P ＜ 0.01 ). In treatment group, the negative ratio of HBeAg was 22.22%, and the ratio of HBeAg seroconversion was 11. 11%, in control group both rates were 27.78% and 16.67% respectively, and there was no difference between the two groups. In treatment group, 88.89% of patients achieved ALT normalization, and in control group achieved 61.11% ( P ＜0.05). After 24weeks, the rebound rate of patients with HBV DNA ＜ 5log10 copies/mL at the end of treatment was 25.00% in tteatment group, and 16.67% in control group. Conclusions ADV can restrain the repliication of HBV in patients who have no response to 12 weeks treatment of interferon-α, but its effect on HBeAg seroconversion is not obvious. ADV is safe in the 52 weeks of treatment, but the end of the treatment is remaining further study.