乙型肝炎病毒YMDD变异的治疗对策

目的探讨慢性乙型肝炎患者发生YMDD病毒变异后的治疗策略。方法 2005年6月-2008年10月在门诊和住院慢性乙型肝炎患者经拉米夫定治疗后出现YMDD变异90例,随机分为3组：A组单用阿德福韦酯10mg/d;B组阿德福韦酯10 mg/d、联合拉米夫定100 mg/d,治疗12周后单用阿德福韦酯10 mg/d治疗36周;C组采用阿德福韦酯10 mg/d、拉米夫定100 mg/d,联合治疗48周。统计方法采用方差分析、q检验和χ^2检验。结果 3组患者治疗12周时ALT水平进一步反弹的患者比例分别为26.7%（8/30）,10.0%（3/30）,6.7%（2/30）;A组与B组、A组与C组间比较,分别为χ^2=3.65、P=0.058,χ^2=5.376、P〈0.05）。A组1例患者出现重型肝炎;治疗12周时3组患者发生YMDD变异分别为16.7%（5/30）,0,0;治疗48周时3组患者间ALT水平差异均无统计学意义;B组、C组ALT复常率、HBVDNA达到检测水平以下的百分率与A组患者比较,χ^2值分别为5.526、6.35、7.054,P值均小于0.05,差异有统计学意义。结论 YMDD变异后采用阿德福韦酯与拉米夫定联合治疗比单用阿德福韦酯治疗更安全有效。

A study on the treatment of chronic hepatitis B with YMDD mutation

Objective To explore the strategy of the treatment of chronic hepatitis B with YMDD mutation. Methods A total of 90 chronic hepatitis B patients with YMDD mutation were randomly assigned into three groups . In group A, patients received adefovir dipivoxil for 48 weeks. In group B, patients were given adefovir dipivoxil in combination with lamivudine during the first 12 weeks and adefovir dipivoxil only for the following 36 weeks. In group C, patients received adefovir dipivoxil in combination with lamivudine for 48 weeks. Results The rate of rebound of alanine aminotransferase （ALT） was 26.7% （ 8/30 ） , 10.0% （ 3/30 ） ,6.7% （ 2/30 ）, （ P 〈 0.05 ） during the first weeks , and one patient with severe hepatitis was found in group A . The positive rate of YMDD mutation was 16.7% （5/30） ,0 and 0 at week 12. There was no significant difference in the level of ALT. At week 48, there was significant difference in the ALT normalization rate and undetectable HBVDNA rate between group A, B and C. Conclusion Adcfovir dipivoxil in combination with lamivudine is a safe and effective therapy for chronic hepatitis B patients with YMDD mutation.