拉米夫定和阿德福韦酯不同时机联合治疗慢性乙型肝炎的疗效观察  

Observation of combination therapies with lamivudine and adefovir diPivoxil at different times for chronic hepatitis B

作　　者：徐晶[1] 潘宏仪 谌翠容[1] 金洁[1] 朱月季[1] 孙振江[1] 俞立飞[1] 卢德荣[1] 潘红英[1] 

机构地区：[1]浙江中医药大学附属第六医院内四科,杭州310014 [2]浙江省浦江县人民医院内科,322200

出　　处：《国际流行病学传染病学杂志》2012年第4期253-256,共4页International Journal of Epidemiology and Infectious Disease

基　　金：杭州市医疗科研及重点专科专病项目（20L00733Q15）

摘　　要：目的比较拉米夫定（LAM）单药治疗发生应答不佳及耐药后联合阿德福韦（ADV）治疗慢性乙型肝炎的疗效与初始联合治疗的差异。方法选择LAM治疗24周后应答不佳和治疗过程中出现耐药的CHB患者各20例，分为A组和B组，初始联合治疗CHB患者20例为C组。三组均给予taM（100ms／d）联合ADV（10rag／d）治疗48周，观察三组治疗前后HBVDNA载量、ALT水平、HaeAg阴转率及YMDD变异情况。结果A、B、C三组患者治疗后HBVDNA阴转率分别为85．00％、80．00％和90．00％，HBeAg转阴率分别为31．3％、30．8％、33．3％，两项指标组间差异均无统计学意义（F=0．784、0．025，P〉0．05）。A、B、C三组患者治疗后HBVDNA水平与治疗前比较差异有统计学意义（t=9．706、10．871、11．807，P〈0．01）；ALT水平治疗前后比较差异也有统计学意义（t=2．157、2．109、2．653，P〈0．05）。经48周联合治疗后三组中共有9例患者HBVDNA仍阳性，但均未检测到YMDD变异。结论LAM联合ADV治疗CHB患者疗效显著，能有效降低CHB患者的HBVDNA及ALT水平，但对HBeAg血清转换的效果并不明显。LAM应答不佳或耐药后联合ADV治疗与初始即采用联合治疗的效果相当。联合治疗后未检测到YMDD变异。Objective To eompare the efficacy of combination therapy with lamivudine（LAM） and adefovir dipivoxil（ADV） for LAM-poorly responsed and LAM-resistant to those de novo combination therapy for chronic hepatitis B （CHB）. Methods Twenty CHB patients with poorly response to LAM were selected as group A, 20 LAM-resistant patients as group B, other 20 CHB patients received combination therapy for the first time as group C. All the patients were given LAM （ 100 mg/d） and ADV （ 10 mg/d） for 48 weeks, the level of HBV DNA, ALT and HBeAg in patients were detected and HBV mutation was detected for whose HBV DNA were still positive after treatment. Results The negative rate of HBV DNA in group A, B and C were 85%, 80%, 90% （ F = 0.784, P 〉 0.05）, and the negative rate of HBeAg were 31.3 %, 30.8 %, 33.3 % （ F = 0.025, P 〉 0.05） in group A, B, C, respectively. The level of HBV DNA and ALT decreased remarkably after 48 combination treatment in group A, B, C （ t = 9.706,10.871, 11.807, P 〈 0.01 ; t = 2.157,2.109,2.653, P 〈 0.05）. HBV DNA in 9 patients were still positive after treatment, but no HBV mutations were detected in three groups. Condusions The combination therapy of LAM and ADV can effectively inhibit HBV replication, improve ALT level in CHB patients, but the efficacy in HBeAg seroconversion rate are not obvious. The efficacy of combination therapy in three groups are similar. No HBV mutations are detected for three groups.

关 键 词：慢性乙型肝炎 拉米夫定 阿德福韦酯 联合治疗 

分 类 号：R512.62[医药卫生—内科学]