慢性乙型肝炎拉米夫定治疗失效者应用阿德福韦酯治疗临床观察  

Study of adefovir dipivoxil on treatment of chronic hepatitis B patients with resistance to lamivudine:a 2-year's clinical course

作　　者：肖扬[1] 郑金莉[1] 张文静[1] 周岳进[1] 胡操寒[1] 胡侠[1] 卢成鸿[1] 潘华将[1] 

机构地区：[1]解放军第一一八医院肝病科,浙江温州325000

出　　处：《肝脏》2008年第4期295-298,共4页Chinese Hepatology

摘　　要：目的观察慢性乙型肝炎拉米夫定治疗失效者应用阿德福韦酯治疗的近期疗效及治疗方案的选择。方法拉米夫定治疗失效患者115例前2月均联用拉米夫定100mg/d和阿德福韦酯10mg/d,此后一组61例单用阿德福韦酯10mg/d,继续治疗22个月;另一组54例继续联用,疗程22个月;对照组85例为初治患者,阿德福韦酯10mg/d治疗24个月。观察患者治疗前、治疗后第1个月、2个月、3个月、6个月、12个月、18个月、24个月肝功能、HBV血清标志物、HBVDNA水平。结果治疗后第24个月时,单用组、联合治疗组、对照组HBVDNA水平对数均值分别为5.9、4.5和4.2log10拷贝/ml;HBVDNA水平对数均值<3log10拷贝/ml者分别占18.0%、20.4%和23.5%,HBVDNA水平对数均值(3～4)log10拷贝/ml者分别占41.6%、48.1%和48.2%,HBVDNA水平对数均值≥5log10拷贝/ml者分别占41.0%、31.5%和28.3%,单用组与其他两组差异无统计学意义(P>0.05)。单用组、联合治疗组、对照组ALT复常率分别为60.7%、64.8%和81.2%,对照组与其他两组差异无统计学意义(P>0.05)。结论拉米夫定治疗失效患者可选用阿德福韦酯治疗,与拉米夫定联合治疗效果更佳,但仍有相当部分患者失效或反弹。Objective To evaluate the clinical effect of adefovir dipivoxil on treatment of patients with chronic hepatitis B（CHB） resistant to lamivudine therapy. Methods 115 patients among 126 cases with CHB failed to lamivudine received 10 mg/d adefovir dipivoxil（ADV） . At first,the patients received 100 mg/d lamivudine again for the first two month,then one group（61 cases） were assigned to 10 mg/d ADV monotherapy for 22 months, the other group（54 cases） were assigned to 10 mg/d ADV and 100 mg/d lamivudine combined therapy for 22 months. The control group （85 cases） without any ant-virus drugs received 10 mg/d ADV monotherapy for 24 months . The patients serum chemical index of liver function, serum immunologic markers of hepatitis B virus, serum HBV DNA and YMDD mutant were detected before treatment,at the first month, second month, third month, sixth month, twelfhh month,eighteenth month and twenty-fourth month after the treatment. Results At the end of the twenty-fourth month, the mean of HBV DNA log10,copies/ml for the monotherapy group, the combined therapy group and the control group decreased to 5.9,4.5 and 4.2,respectively; The proportion of HBV DNA 〈3 log10,copies/mlwere 18.0% ,20.4% and 23.5%,respectively; The proportion of HBV DNA 〈5 log10 copies/ml and 〉3 log10, were 41.6%, 48.1% and 48.2% ,respectively; the proportion of HBVDNA ≥5 log10 were41.0% ,31.5 %和 28.3%, respectively. The rate of the monotherapy group had not difference statistically（P〉0.05） compared with other two groups. The proportion of ALT normalization for the three groups were 60.7%, 64.8% and 81.2 %. respectively. The rate of the control had not difference statistically（P〉0.05） compared with other two groups. Conclusion The patients with CHB failed to lamivudahe could take ADV,and combinated with lamivudine better, but not all the patients efficacy with lamivudine resistance are satisfactory, some would be refractory or failed.

关 键 词：慢性乙型肝炎 拉米夫定 阿德福韦酯 

分 类 号：R512.62[医药卫生—内科学] R587.1[医药卫生—临床医学]