拉米夫定抗乙肝病毒应答不佳联合应用阿德福韦酯的疗效分析

目的 探讨拉米夫定抗乙肝病毒(HBV)应答不佳增用阿德福韦酯的疗效及耐药性.方法 对218例血清丙氨酸氨基转移酶(ALT)升高、HBV-DNA载量为1.0×104～1.0×108拷贝/ml的HBeAg阳性慢性乙肝初治患者应用拉米夫定治疗,治疗24周时检测HBV-DNA水平.如果达到检测下限值(HBV-DNA＜500拷贝...

Analysis of the therapeutic effects and drug-resistance of adefovir dipivoxil on patients responded poorly to lamivudine in the management of hepatitis B virus infection

Objective To analyze the therapeutic effects and drug-resistance of adefovir dipivoxil on patients who responded poorly to lamivudine in the management of hepatitis B virus infection.Methods 218 naive HBeAg(+) chronic hepatitis B patients with elevated serum alanine aminotransferase(ALT) and viral load of 1.0x104~1.0x108 copies/ml were treated with lamivudine for 24 weeks,then HBV-DNA level was measured.The patients were treated with lamivudine alone if their HBV-DNA in undetectable level(HBV-DNA<500 copies/ml),on the other hand,patients were given lamivudine plus adefovir dipivoxil treatment regimen if their HBV-DNA level was higher than the detectable limit.All patients were followed-up for 48 weeks.Results HBV-DNA levels were less than 500 copies/ml in 61.9%(135/218) patients after treatment for 24 weeks.Serum ALT normalization rates were 86.7%(117/135) and 89.2%(74/83) in single-drug group and combined-treatment group at week 48,respectively(P > 0.05).The incidence of HBeAg negative and HBeAg seroconversion in single-drug group were 20.0%(27/135) and 16.3%(22/135),and were 20.5%(17/83) and 14.5%(12/83) in combined-treatment group(P > 0.05),respectively.The HBV-DNA level less than 500 copies/ml occurred in 88.1%(119/135) patients with single-drug therapy and 85.5%(71/83) patients with combined-treatment regimen(P > 0.05).In term of incidence of genotypic resistance,it was 11.9%(16/135) in single-drug group and 3.6%(3/83) in combined-treatment group(P < 0.05).Conclusion In patients who responded poorly to lamivudine,adefovir dipivoxil can be used safely and effectively in the treatment of chronic hepatitis B patients with HBeAg(+),and it can reduce the incidence of drug-resistance.