拉米夫定抗乙肝病毒应答不佳联合应用阿德福韦酯的疗效分析  

Analysis of the therapeutic effects and drug-resistance of adefovir dipivoxil on patients responded poorly to lamivudine in the management of hepatitis B virus infection

作　　者：郭新会[1] 金瑞[1] 张世斌[1] 徐斌[1] 朱任平[1] 张月宁[1] 边新渠[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病科,100069

出　　处：《北京医学》2011年第9期717-720,共4页Beijing Medical Journal

摘　　要：目的探讨拉米夫定抗乙肝病毒(HBV)应答不佳增用阿德福韦酯的疗效及耐药性。方法对218例血清丙氨酸氨基转移酶(ALT)升高、HBV-DNA载量为1.0×104～1.0×108拷贝/ml的HBeAg阳性慢性乙肝初治患者应用拉米夫定治疗,治疗24周时检测HBV-DNA水平。如果达到检测下限值(HBV-DNA<500拷贝/ml)则继续应用拉米夫定治疗(单药治疗组),未达到检测下限值者则加用阿德福韦酯(联合治疗组)。所有患者随访至48周。结果拉米夫定治疗至24周时,135例(61.9%)患者HBV-DNA<500拷贝/ml,83例(38.1%)HBV-DNA>500拷贝/ml;治疗至48周时,单药治疗组和联合治疗组的ALT复常率(ALT≤40U/L)分别为86.7%(117/135)和89.2%(74/83),两组比较无显著性差异(P>0.05)。单药治疗组的HBeAg转阴率和HBeAg血清学转换率(HBeAg阴性、HBeAb阳性)分别为20.0%(27/135)和16.3%(22/135),联合治疗组分别为20.5%(17/83)和14.5%(12/83),两组比较无显著性差异(P>0.05)。单药治疗组基因型耐药率为11.9%(16/135),联合治疗组为3.6%(3/83),两组比较有显著性差异(P<0.05)。结论对拉米夫定治疗24周的抗HBV应答效果不佳者,增用阿德福韦酯治疗至48周,可显著减少耐药的发生,但未明显增加HBeAg血清转换率。Objective To analyze the therapeutic effects and drug-resistance of adefovir dipivoxil on patients who responded poorly to lamivudine in the management of hepatitis B virus infection.Methods 218 naive HBeAg（＋） chronic hepatitis B patients with elevated serum alanine aminotransferase（ALT） and viral load of 1.0x104~1.0x108 copies/ml were treated with lamivudine for 24 weeks,then HBV-DNA level was measured.The patients were treated with lamivudine alone if their HBV-DNA in undetectable level（HBV-DNA500 copies/ml）,on the other hand,patients were given lamivudine plus adefovir dipivoxil treatment regimen if their HBV-DNA level was higher than the detectable limit.All patients were followed-up for 48 weeks.Results HBV-DNA levels were less than 500 copies/ml in 61.9%（135/218） patients after treatment for 24 weeks.Serum ALT normalization rates were 86.7%（117/135） and 89.2%（74/83） in single-drug group and combined-treatment group at week 48,respectively（P 0.05）.The incidence of HBeAg negative and HBeAg seroconversion in single-drug group were 20.0%（27/135） and 16.3%（22/135）,and were 20.5%（17/83） and 14.5%（12/83） in combined-treatment group（P 0.05）,respectively.The HBV-DNA level less than 500 copies/ml occurred in 88.1%（119/135） patients with single-drug therapy and 85.5%（71/83） patients with combined-treatment regimen（P 0.05）.In term of incidence of genotypic resistance,it was 11.9%（16/135） in single-drug group and 3.6%（3/83） in combined-treatment group（P 0.05）.Conclusion In patients who responded poorly to lamivudine,adefovir dipivoxil can be used safely and effectively in the treatment of chronic hepatitis B patients with HBeAg（＋）,and it can reduce the incidence of drug-resistance.

关 键 词：慢性乙型肝炎 拉米夫定 阿德福韦酯 基因突变 耐药 

分 类 号：R512.62[医药卫生—内科学]