阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎的临床疗效观察

目的:观察阿德福韦酯单用或联合拉米夫定治疗HBeAg阳性YMDD变异慢性乙型肝炎的临床疗效。方法YMDD变异乙型肝炎患者87例,分A组45例(阿德福韦酯10mg 1次/d;拉米夫定100 mg 1次/d连续72周),B组42例(单用阿德福韦酯,方法剂量同A组);动态观察患者血清HBV DNA、HBeAg/HBeAb和肝功能变化。结果A组HBV DNA阴转率在12、24、48、72周时分别为35.0%、42.5%、70.0%、77.5%;B组分别为33.3%、46.2%、66.7%、51.3%,但两组之间比较在72周时差异有统计学意义(P<0.05);A组HBeAg阴转率在72周时明显高于B组(P<0.05);比较两组ALT复常率在12周时A组明显高于B组(P<0.05)。结论阿德福韦酯单独或联合拉米夫定,对YMDD变异的慢性乙型肝炎均有治疗作用;联合用药效果更好。

Clinical Study of Adefovir Dipivoxil Alone or in Combination with Lamivudine in Treatment of Chronic Hepatitis B with YMDD Mutation

Objective:To survey the therapeutic effect of adefovir dipivoxil alone or in combination with lamiudine in the treatment of chronic hepatitis B with YMDD mutation.Methods Eighty-seven patients with chronic hepatitis B with YMDD mutation were divided into two groups:A and B.The patients of group A(n=45) were given each 10mg adefovir dipivoxil po qd,in the meantime,each of them was given 100mg of lamiudine po qd,for 72weeks.Patients of group B(n=42) were subjected to adefovir dipivoxi alone treatment at the same dosage as well as that of patients in group A.Changes in serum HBV DNA,HBeAg/HBeAb and liver functions were dynamically monitored.Results At the end of the 12,24,48 and 72 weeks of treatment,the rates of sera to turn negative for HBV DNA were 35.0%,42.5%,70.0%and 77.5%,respectively, in patient s of group A,and 33.3%,46.2%,66.7%,and 51.3%,respectively,in patient s of group B.The rates of sera to turn negative for HBV DNA,in patients of group A were significantly higher than those in patient s of group B(P<0.05) only after 72 weeks.At the end of the 72 weeks of treatment the rate of HBeAg loss in group A was significantly higher than in group B(P<0.05).At the end of the 12 weeks,the rate of ALT normalization in patient s of group A was significantly higher than that in patient s of group B(P<0.05).Conclusions Chronic hepatitis B with YMDD mutation patients has a good response to both the combination therapy and the monotherapy.Administration of the two drugs in combination is capable of improving the better therapeutic effects.