阿德福韦酯联合拉米夫定治疗拉米夫定耐药慢性乙型肝炎患者的临床研究

目的 研究拉米夫定耐药的慢性乙型肝炎(CHB)患者继续服用拉米夫定并联合阿德福韦酯治疗的疗效及安全性.方法 采用随机对照的方法.按1:1比例将64例拉米夫定耐药的CHB患者随机分为治疗组与对照组,每组各32例,治疗组服用拉米夫定100 mg/d+阿德福韦酯10mg/d,连用52周,对照组单独应用阿德福韦酯10mg/d,连用52周,在治疗24周及52周时观察两组患者血清HBV DNA转阴、HBeAg转阴、HBeAg转换、ALT复常及治疗52周时阿德福韦酯耐药情况.结果 治疗52周时治疗组HBV DNA转阴率81%(26/32),HBeAg转阴率47%(15/32),HBeNg转换率38%(12/32),ALT复常率94%(30/32),与对照组的53%(17/32)、22%(7/32)、12%(4/32)、69%(22/32)比较差异有统计学意义(P<0.05),治疗过程中未发现严重不良反应.结论 阿德福韦酯联合拉米夫定治疗拉米夫定耐药CHB患者在病毒学、血清学及生化学方面取得较好的疗效,且耐药率低、安全性良好.

Clinical study on adefovir and lamivudine in treatment of chronic type B hepatitis patients with lamivudine medicine endurance

Objective To study the curative effect and the security of lamivudine (LM) and adefovir (AD) in the treatment of chronic type B hepatitis (CHB) patients with lamivudine medicine endurance. Methods The random-control method was used. Sixty-four CHB patients with LM endurance were randomized into treatment group (32 cases) and control group (32 cases). The patients in treatment group took LM 100 mg/d+AD 10 mg/d,and the patients in control group used AD 10 mg/d only. All of the patients were treated for 52 weeks. When treated for 24 weeks and 52 weeks, the HBV DNA transfer ratio, the HBeAg transfer ratio, the, HBeAg serology transfer ratio, the ALT restoration ratio, AD security and AD endurance rate in the 52th week were observed. Results The HBV DNA transfer ratio, the HBeAg transfer ratio, the HBeAg serology transfer ratio and the ALT restoration ratio in treatment group after 52 weeks' treatment were 81%(26/32),47% (15/32), 38% (12/32) and 94%(30/32). And those in control group were 53% (17/32), 22% (7/32), 12% (4/32) and 69% (22/32). There were significant differences between two groups (P < 0.05). No serious side effect was found in the course of treatment. Conclusion AD combined with LM has good curative effects in the virology, serology and biochemical aspect of LM endurance patients with lower medicine resistance and good security.