拉米夫定与阿德福韦酯初始联合治疗HBeAg阳性慢性乙型肝炎96周疗效观察  

The observation of 96-weeks efficacy of lamividine plus adefovir combination initial therapy for HBeAg positive chronic hepatitis B

作　　者：任娜[1] 闫杰[1] 蔡晧东[1] 吴璐[1] 

机构地区：[1]北京首都医科大学附属北京地坛医院,100015

出　　处：《国际病毒学杂志》2012年第3期113-117,共5页International Journal of Virology

基　　金：北京市卫生局青年科研基金（QN2010-032）

摘　　要：目的观察拉米夫定（LAM）和阿德福韦酯（ADV）初始联合治疗HBeAg阳性的慢性乙制肝炎（CHB）的长期疗效与安全性。方法自首都医科大学附属北京地坛医院肝病中心2009年2月-2009年5月开始初始抗病毒治疗的HBeAg阳性CHB患者中，选择ETV单药治疗患者、LAM和ADV联合治疗患者各25例进行前瞻性观察；比较治疗96周时两组患者在病毒学应答率、生化学应答率及免疫学应答率等方面有无差异。结果经过96周抗病毒治疗，取得完全病毒学应答的患者在ETV组为19／22例（86．4％），而联合治疗组仅有9／21例（42．9％），二者差异显著（X^2=8．953，P=0．003）；在肝脏生化学应答方面两组均取得明显改善；两组的HBeAg阴转、HBe血清学转换、HBsAg阴转等免疫控制指标均无明显变化。两组患者在为期96周的治疗随访过程中，均未发生病毒学突破或HBVDNA反跳。两组患者在为期96周的治疗随访过程中，未发现任何不良反应。两组患者的。肾功能在基线及96周时均处于正常范围，且治疗前后无显著性差异。结论在HBeAg阳性CHB初始抗病毒治疗患者中，应用ETV单药治疗组的96周病毒学应答率显著高于LAM和ADV联合治疗组。Object Observed the long-term efficacy and safety of lamivudine （ LAM ） and adefo- vir dipivoxil （ ADV ） initial in the treatment of HBeAg positive chronic hepatitis B （ CHB ） . Methods In this prospective observation study, we selected 50 CHB patients of the HBeAg positive taking the initial antivirus therapy in the period of February 2009 to May 2009, who were from the liver disease treatment cen- ter of Beijing Ditan Hospital of the Capital Medical University. and averagely divided them into 2 treatment groups：one is the group of ETV monotherapy （ group ETV） , and the other is the group of LAM and ADV combined treatment （ combined treatment group ）. After 96 weeks treatment the rates of virological and im- munological response had no differences between the patients of the two groups. Results After 96 weeks antivirus treatment, 19/22 patients （ 86. 4% ） of the ETV group achieved complete virological response, thecombined treatment group were only 9/21 cases （42. 9% ）, and the results had significant difference （ X^2 = 8. 953, P = 0. 003 ） ; all the patients of the two groups have achieved significant improvement in the liver bio- chemical responses; for the patients of two groups, the immune control indicators （e. g. HBeAg,HBsAg con- verting to negative, the serologic conversion of HBe series） did not obviously change. During the period of 96 weeks for the treatment, there were no virological breakthrough or HBV DNA bounce. During the period of 96 weeks for the treatment, there were no adverse reaction happened on the patients of the two groups. The results about the renal function of the patients in the baseline point and the 96th week were all in the normal range in two groups, and there were no significant difference before and after the treatment. Conclu- sion In those CHB patients of HBeAg positive, after 96 weeks inital antiviral therapy, the rates of the viro- logical response using the method of application of ETV monotherapy were significantly higher than that of

关 键 词：乙型肝炎 慢性 拉米夫定 阿德福韦酯 恩替卡韦 治疗 

分 类 号：R512.62[医药卫生—内科学]