阿德福韦酯治疗替比夫定耐药慢性乙型肝炎疗效初探  

Pilot Study on the Adefovir Dipivoxil Monotherapy in Telbivudine Resistant Patients with Chronic Hepatitis B

作　　者：任江波[1] 王宇[1] 李红艺[1] 孙淑杰[1] 马红[1] 贾继东[1] 

机构地区：[1]首都医科大学附属北京友谊医院肝病中心

出　　处：《首都医科大学学报》2010年第5期566-569,共4页Journal of Capital Medical University

基　　金："十一五"国家重大科技专项(2008ZX10002-004);首都医学发展科研基金(2007-1021)~~

摘　　要：目的观察阿德福韦酯(adefovir dipivoxil,ADV)治疗替比夫定(telbivudine,LDT)耐药的慢性乙型肝炎患者病毒学、血清学、生物化学应答及耐药发生情况。方法13名(10人HBeAg阳性,3人HBeAg阴性)替比夫定治疗耐药的患者,换用ADV10 mg/d治疗。治疗期间每12周随访1次,检测血清HBV DNA、HBV标志物、生化指标。HBV DNA检测下限为<300 copies/mL。结果治疗前HBV DNA为3.9×109copies/mL(9.0×104copies/mL^2.0×109copies/mL),治疗12、24、48周时HBV DNA分别下降3.77、4.28、5.31 lg copies/mL,且随着治疗时间延长,病毒载量继续下降。血清丙氨酸氨基转移酶(alanineaminotransferase,ALT)水平随HBV DNA下降逐渐复常。48~96周治疗期间没有发生血清学转换和耐药。结论换用ADV单药治疗LDT耐药患者,可快速有效降低血清病毒载量,48~96周期间未发现阿德福韦酯耐药。Objective Adefovir dipivoxil（ADV） is effective in treatment of lamivudine（LAM）-resistant chronic hepatitis B（CHB）.However,the effect of ADV monotherapy on telbivudine（LdT）-resistant CHB needs to be elucidated.The aim of this study was to observe the efficacy and resistance of ADV monotherapy in LdT-resistant patients.Methods Thirteen LDT-resistant CHB patients（10 HBeAg positive patients and 3 HBeAg negative patients） were treated with 10 mg ADV once daily at least 48 weeks,follow-up was performed every 12 weeks and virological,serological and biochemical responses were explored.Virological response was defined as HBV DNA 300 copies/mL.Results The baseline median HBV DNA was 3.9×109 copies/mL.Viral load was decreased 3.77,4.28 and 5.31 lg copies/mL at 12,24 and 48 weeks and dropped persistently with the therapy continuation.Biochemical response（ALT） was obtained after virological response.There was no serological response and ADV resistance after 96 week treatment with ADV.Conclusion Switching to ADV monotherapy in LdT-resistant patients with CHB can reduce HBV DNA rapidly and effectively.No ADV resistance was found during up to 96 weeks treatment.

关 键 词：阿德福韦酯 替比夫定 耐药 慢性乙型肝炎 

分 类 号：R575[医药卫生—消化系统]