阿德福韦酯耐药分析  

Drug resistance of adefovir dipivoxil

作　　者：范振平[1] 吉英杰[1] 秦立[2] 徐东平[3] 张海燕[1] 史雪敏[1] 王雪芹[1] 蔡少平[1] 卜昕[1] 何卫平[1] 张文瑾[1] 

机构地区：[1]解放军第三〇二医院军人肝病诊疗中心,北京100039 [2]解放军第三〇二医院药学部,北京100039 [3]解放军第三〇二医院肝衰竭诊疗与研究中心,北京100039

出　　处：《传染病信息》2013年第2期119-122,共4页Infectious Disease Information

基　　金：解放军第三〇二医院院内课题(YNKT20111016)

摘　　要：阿德福韦酯(ADV)主要用于慢性乙型肝炎(乙肝)初治和拉米夫定(LAM)耐药后的治疗。ADV耐药特别是多重耐药已成为临床常见且棘手的问题。乙肝初治患者使用ADV最常见的原发性耐药突变类型为rtA181V/T和rtN236T,最常见的多重耐药类型为rtL180M┼M204V┼A181V。RtA181V/T对恩替卡韦(ETV)和替诺福韦酯(TDF),rtN236T对LAM和ETV保持活性;多重耐药主要与LAM→ADV或LAM→ADV→ETV的序贯治疗有关。临床上应根据检出的耐药类型,首选LAM┼ADV、ETV┼ADV联合治疗或改用TDF。LAM耐药后,国内现有药物中应首选加用ADV,而非改用ETV。Adefovir dipivoxil （ADV） is mainly used in nave and lamivudine （LAM）-resistant patients with chronic hepatitis B （CHB）. However, ADV resistance, especially multidrug resistance （MDR） to ADV is becoming more frequent and complicated in clinical practice. Generally, in naYve CHB patients, the most frequent primary ADV resistances are rtA181V/T and rtN236T, and the most frequent MDRs to ADV are rtL180M＋M204V＋A181V. As for treatment, the resistant mutation of rtA181V/T is sensitive for enticavir （ETV） and tenofovir （TDF）, and that of rtN236T for LAM and ETV. MDR to ADV is mainly associated with squential treatment with LAM and ADV or LAM, ADV and ETV. Clinically, according to the resistance types, LAM or ETV add-on ADV combination therapy is firstly recommended for MDR to ADV, and TDF switching therapy is also another optimal option. Furthermore, ADV addon LAM therapy is the first option for LAM-resistant patients instead of ETV switching therapy.

关 键 词：抗病毒药 乙型肝炎 慢性 抗药性 

分 类 号：R512.62[医药卫生—内科学]