阿德福韦酯联合拉米夫定治疗慢性乙型肝炎疗效分析

目的：探讨阿德福韦酯联合拉米夫定治疗慢性乙型肝炎的临床疗效。方法将慢性乙型肝炎患者68例，采用随机数字表法分为治疗组和对照组，每组34例。治疗组使用阿德福韦酯联合拉米夫定给药48周，对照组单独采用拉米夫定给药48周，分别在12、24、36、48周时，观察并比较患者治疗后肝功能指标中ALT的变化、HBV DNA 血清变化、HBV DNA 与 HBeAg 转阴率、HBeAg/HBeAb 血清转换率及不良反应。结果两组患者随治疗时间的延长，ALT、HBV DNA定量逐渐下降，治疗前后差异均有统计学意义（ t＝4．63、4．65，均P＜0．05）；治疗组24、36、48周ALT、HBV DNA均明显低于对照组[ALT（89．9±16．7）U/L、（60．1±13．8）、U/L（44．6±8．9）U/L比（90．7±17．6）U/L、（72．0±14．1）U/L、（61．3±24．5）U/L；HBV DNA（4．92±1．44）U/L、（3．35±1．37）U/L、（2．53±1．31）U/L比（5．02±1．41）U/L、（3．69±1．40）U/L、（3．02±1．35）U/L]，两组差异均有统计学意义（F＝4．32、4．56、4．76，均P＜0．05）；两组患者治疗后，HBV DNA与HBeAg阴转率、HBeAg/HBeAb血清转换率均有显著上升，差异均有统计学意义（χ2＝4．63、4．36、4．21、4．27、4．35、4．23，均P＜0．05）；在治疗24周时，HBV 血清学标志差异无统计学意义，24周后血清学标志物治疗组（67．65％、32.35％、26．47％、85．29％、38．23％、35．29％）明显高于对照组，两组差异均有统计学意义（χ2＝4．43、4．73、4.23、4．32、4．34、4．46、4．76、4．34、4．22、4．29、4．34、4．45，均P＜0．05）。结论阿德福韦酯联合拉米夫定治疗慢性乙型肝炎临床疗效显著，无严重不良反应，适宜临床广泛应用。

Clinical efficacy of adefovir and lamivudine in the treatment of chronic hepatitis B

Objective To study the clinical curative effect of adefovir and lamivudine in the treatment of chronic hepatitis B .Methods 68 patients with chronic hepatitis B were randomly divided into the treatment group and control group,34 cases in each group.The treatment group was treated with adefovir and lamivudine for 48 weeks,the control group was treated by lamivudine for 48 weeks.12,24,36,48 weeks after treatment ,the changes of liver func-tion,ALT index in HBV DNA,HBV DNA and the changes of serum HBeAg negative rate ,HBeAg/HBeAb seroconver-sion rate and adverse reaction were observed and compared .Results With the extension of treatment time ,ALT,HBV DNA in the two groups were gradually decreased , there were significant differences before and after treatment （ t=4.63,4.65,P〈0.05）.24,36,48 weeks after treatment,ALT,HBV DNA in the treatment group were significantly lower than those in the control group[ALT （89.9 ±16.7） U/L,（60.1 ±13.8） U/L,（44.6 ±8.9） U/L vs （90.7 ± 17.6） U/L,（72.0 ±14.1） U/L,（61.3 ±24.5） U/L;HBV DNA （4.92 ±1.44） U/L,（3.35 ±1.37） U/L,（2.53 ± 1.31） U/L vs （5.02 ±1.41） U/L,（3.69 ±1.40） U/L,（3.02 ±1.35） U/L],there were significant differences between two groups（F=4.32,4.56.4.76,all P〈0.05）.After treatment,the HBV DNA and HBeAg negative con-version rate,HBeAg/HBeAb seroconversion rate in two groups were increased significantly ,the differences were statis-tically significant（χ2 =4.63,4.36,4.21,4.27,4,35,4.23,all P〈0.05）.At the 24th week of treatment,the serolog-ical markers of HBV had no significant difference , but after 24 weeks, serum markers in the treatment group （67.65%,32.35%,26.47%,85.29%,38.23%,35.29%） were obviously higher than those in the control group , the differences between the two groups were significant （χ2 =4.43,4.73,4.23,4.32,4.34,4.46,4.76,4.34,4.22, 4.29,4.34,4.45,all P〈0.05）.Conclusion Adefovir and lamivudine combination therapy in the treatment of chro-nic hepatitis B has obvious clinical ef