阿德福韦酯联合拉米夫丁治疗拉米夫丁耐药失代偿期肝硬化患者14例  

Adefovir combined with lamivudine in treatment of lamivudine-resistant patients with decompensated liver cirrhosis:an analysis of 14 cases

作　　者：王方[1] 张俊[1] 张小岗[2] 张静[1] 李德明[1] 

机构地区：[1]中国人民解放军兰州军区总医院安宁分院感染科,甘肃省兰州市730070 [2]甘肃省中医院骨科,甘肃省兰州市730050

出　　处：《世界华人消化杂志》2008年第13期1468-1470,共3页World Chinese Journal of Digestology

摘　　要：目的:观察阿德福韦酯(贺维力)联合拉米夫丁治疗拉米夫丁耐药的慢性乙型肝炎肝硬化失代偿期患者的疗效和安全性.方法:选择拉米夫丁治疗后产生耐药的HBsAg、HBeAg和HBcAb阳性、HBVDNA>108copies/L的肝硬化失代偿期患者14例,加用阿德福韦联合抗病毒治疗,于治疗6mo后观察疗效及不良反应.结果:联合治疗6mo后患者ALT、AST、TBIL、Alb、PTA水平较联合治疗前明显改善,ALT、AST和TBIL复常患者的比例分别为57.1%、42.8%、50.0%;HBVDNA<105copies/L、HBeAg转阴、HBeAg/抗HBeAb转化的患者比例分别为50.0%、28.4%和7.1%;产生腹水的患者腹水全部消退,对肾功能无明显影响,治疗期间未观察到阿德福韦相关的变异.结论:阿德福韦联合拉米夫丁治疗拉米夫丁耐药的肝硬化失代偿期患者的疗效肯定,安全性好.AIM：To observe the efficacy and safety of adefovir in combination with lamivudine in the treatment of lamivudine-resistant patients with decompensated liver cirrhosis. METHODS：Fourteen decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus（HBV）mutants,positive HBsAg, HBeAg,and HBcAb,and HBV DNA level〉10 8 copies/L were treated with lamivudine in combination with adefovir.The clinical efficacy after 6 mo and the adverse reaction during treatment were observed.RESULTS：The levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）, total bilirubin（TBIL）,albumin（Alb）,and prothrombin activity（PTA）were improved distinctly after 6-mo combined treatment.The levels of serum ALT,AST and TBIL became normal in 57.1%,42.8%,and 50.0%of patients, respectively.The percentages of patients with undetectable HBV DNA levels（〈10 5 copies/L）, seropositive HBeAg and seroconversion were 50.0%,28.4%and 7.1%,respectively.Ascites was retrogressed in those accompanied with ascites.There were no obvious renal toxicity and adverse reation.No adefovir-related HBV mutations were identified. CONCLUSION：Combined treatment with lamivudine and adefovir is stable and safe for lamivudine-resistant patients with decompensated liver cirrhosis.

关 键 词：失代偿期肝硬化 阿德福韦酯 拉米夫丁 耐药 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]