替比夫定联合阿德福韦酯治疗阿德福韦酯应答不佳的乙型肝炎病毒e抗原阳性慢性乙型肝炎患者

目的评估替比夫定与阿德福韦酯联合治疗优化阿德福韦酯单药治疗应答不佳的阳性慢性乙型肝炎患者的疗效。方法选择2008年6月-2009年8月间共26例阿德福韦酯治疗至少12个月且病毒学应答不佳的乙型肝炎病毒e抗原(HBeAg),阳性的慢性乙型肝炎患者,在10 mg阿德福韦酯治疗的基础上,加用600 mg替比夫定。肝功能和乙型肝炎病毒(HBV)DNA每3个月评估1次,乙型肝炎两对半和腹部B型超声每半年评估1次。结果在第1年的治疗期间,所有患者血清HBV DNA水平均呈进行性下降,其中24例(92.3%)血清HBV DNA水平在联合治疗12个月时低于检测值下限,有25例(96.2%)患者丙氨酸转氨酶水平复常。治疗6个月时,分别有7例(26.9%)和2例(7.7%)患者发生HBeAg消失和血清学转换;治疗12个月时,分别有11例(42.3%)和8例(30.8%)患者发生HBeAg消失和血清学转换。整个治疗期间,26例患者均未出现病毒学突破。结论阿德福韦酯单药治疗应答不佳时,加用替比夫定可有效控制病毒,使患者获得较好的病毒学、生化学和免疫学应答。

Efficacy of Telbivudine Combined with Defovir Dipivoxil on Positive-HBeAg Chronic Hepatitis B Patients with Suboptimal Response to Adefovir Dipivoxil

Objective To evaluate the curative efficacy of telbivudine combined with defovir dipivoxil on positive-HBeAg chronic hepatitis B patients with suboptimal response to adefovir dipivoxil.Methods A total of 26 HBeAg-positive patients with suboptimal response to adefovir dipivoxil(treated with adefovir dipivoxil for more than 12 months) were treated with adefovir dipivoxil 10 mg in addition to telbivudine 600 mg between June 2008 and August 2009.Liver function and serum hepatitis B virus(HBV) DNA tests were assessed at the baseline and 3-month intervals,whereas HBV serological markers and abdominal ultrasonography were carried out every 6 months.Results During the first year of treatment,all patients showed a progressive decline of serum HBV DNA levels;while undetectable serum HBV DNA and normalization of alanine aminotransferase was achieved in 24(92.3%) and 25(96.2%) patients,respectively,at the end of the first year of treatment.The 6-and 12-month cumulative rates of HBeAg loss were 26.9%(7/26) and 42.3%(11/26),respectively;and corresponding cumulative rates of HBeAg/anti-HBe seroconversion were 7.7%(2/26) and 30.8(8/26),respectively.During the observation period,no virological breakthrough was detected.Conclusion Telbivudine combined with defovir dipivoxil may be a good choice for patients with suboptimal response to adefovir dipivoxil,which could induce effective viral inhibition and help patients obtain more virological,biochemical and immunological responses.