阿德福韦酯初治慢性乙型肝炎患者药物调整原因及疗效分析  

Factors of switched treatments in adefovir-naive patients with chronic hepatitis B

作　　者：杨玥[1] 张振华[1] 张亚飞[1] 周琴[1] 靳艳艳[1] 李旭[1] 

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥市230022

出　　处：《实用肝脏病杂志》2013年第2期134-136,共3页Journal of Practical Hepatology

基　　金：安徽省卫生厅医学科研课题(编号:09A069/2010C053);高等学校博士学科点专项科研基金(编号:20093420120005)

摘　　要：目的探讨阿德福韦酯(ADV)初治慢性乙型肝炎患者调整治疗方案的原因及调整后治疗疗效。方法在109例ADV初始治疗的慢性乙型肝炎患者中,42例(38.5%)因故调整了治疗方案,其中30例加用拉米夫定(LAM)或替比夫定(LDT),10例换用LAM或LDT或恩替卡韦(ETV),2例改为干扰素-α(IFN-α)继续治疗。结果在治疗12周内,因原发性无应答调整者4例(9.5%)和不明原因调整1例(2.4%),在24周内因部分病毒学应答调整者6例(14.3%),在48周内因病毒学突破调整者10例(23.8%)和生化学突破1例(2.4%),在96周内因病毒学突破调整者12例(28.6%)、生化学突破调整者4例(9.6%)、准备怀孕2例(4.8%)、血清Cr升高1例(2.4%)和不明原因1例(2.4%);42例调整治疗者男性占95.2%,而67例未调整者男性占79.1%(P<0.05),HBeAg阳性率为78.6%,而后者为52.2%(P<0.05);在治疗48周,67例未调整治疗患者ALT复常率为68.7%,明显高于调整组(47.6%,P<0.01),HBV DNA转阴率为95.5%,明显高于调整组(57.1%,P<0.01);在治疗96周,两组患者ALT复常、HBeAg转阴和HBV DNA转阴率均无显著性相差(P>0.05)。结论男性和HBeAg阳性患者在ADV初治期间可能更需要变更治疗方案。对于已经选择ADV初始治疗的CHB患者,在换药治疗后仍能获得满意的疗效。Objective To explore the factors leading to switching treatments in adefovir-naive patients with chronic hepatitis B （CHB）. Methods A total of 109 patients with CHB were treated with adefovir dipivoxil （ADV）. Out of them,42 （38.5%）changed the treatment regimen,and 30 had ADV and lamivudine or telbivudine combination, 10 switched to lamivudine or telbivudine or entecavir,and 2 switched to interferon-α therapy. Re- suits At the end of 12 weeks,four（9.5%）patients changed treatment regimen because of primary non-response and one （2.4%）without definite reason;at the end of 24 weeks,six（14.3%）patients changed because of partial virologi- cal response,and at the end of 48 weeks,10 （23.8%）changed because of virological breakthrough （VB） and one （2.4%）of biochemical breakthrough （BB）;at the end of 96 weeks,12（28.6%）of VB,4（9.6%）of BB,2（4.8%）of con- sidering pregnancy,one（2.4%）of elevated serum creatinine levels and one（2.4%）of no cause;male patients account- ed for 95.2% in 42 switched patients,while for 79.1%（P〈0.05）in 67 patients still having ADV treatment,and serum HBeAg positive rate was 78.6% in the former,while it was 52.2%（P〈0.05）in the latter;the serum ALT normaliza- tion rate was 47.6% in 42 patients with switched treatment at the end of 48 week observation,much lower than 68.7%（P〈0.01）in 67 patients without switched treatment,and the HBV DNA loss was 57.1% in the former,much lower than 95.5% in the latter（P〈0.01 ）;at the end of 96 week observation, the ALT normalization,HBcAg negativity and HBV DNA loss rates were not significantly different in the two groups （P〉0.05）. Conclusion The male and HBeAg-positive patients with CHB require changing ADV treatment in time to improve the long-term efficacy.

关 键 词：慢性乙型肝炎 阿德福韦酯 初始治疗 调整治疗方案 

分 类 号：R512.62[医药卫生—内科学]