恩替卡韦联合阿德福韦酯治疗耐拉米夫定慢性乙型肝炎患者48周的疗效分析  

Effective analysis of using entecavir in combination with adefovir dipivoxil for a 48-week of chronic hepatitis B patients with lamivudine-resistance

作　　者：蒋亦明[1] 梁军才[2] 陈晓笑[3] 龚力[4] 鲍军[5] 

机构地区：[1]无锡市第五人民医院感染科,214000 [2]杭州市萧山区第一人民医院消化科,312000 [3]常州卫生高等职业技术学校,213000 [4]昆山市第一人民医院感染科,215300 [5]江苏省老年医院消化科,江苏南京210000

出　　处：《国际消化病杂志》2014年第6期401-405,共5页International Journal of Digestive Diseases

摘　　要：目的观察恩替卡韦(ETV)联合阿德福韦酯(ADV)治疗耐拉米夫定(LAM)慢性乙型肝炎的疗效。方法选取LAM耐药患者66例,随机分成两组,治疗组36例应用ETV联合ADV挽救治疗,对照组30例应用LAM联合ADV挽救治疗,观察两组治疗前及治疗后12周、48周谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、乙型肝炎病毒DNA(HBV-DNA)、乙型肝炎e抗原(HBeAg)含量变化以及治疗48周时非rtM204I位点变异发生率。结果治疗组挽救治疗后12周ALT和AST分别降至(36.5±13.23)U/L和(50.2±11.66)U/L,显著低于同期对照组ALT[(60.3±12.28)U/L,P<0.01]及AST[(69.7±13.56)U/L,P<0.01]含量;治疗后48周治疗组ALT和AST降至(27.9±10.58)U/L和(26.7±10.95)U/L,低于同期对照组ALT[(50.4±11.53)U/L,P<0.01]及AST[(44.9±15.33),P<0.05]含量。治疗12周及48周,治疗组HBV-DNA转阴率分别为85.5%及91.7%,显著高于同期对照组转阴率(53.3%和73.3%,P均<0.05)。治疗组48周后出现1例新的非rtM204I位点变异,而对照组非rtM204I位点变异情况为6例,两组相比差异有统计学意义(χ2=5.12,P=0.024)。结论 ETV联合ADV用于既往LAM耐药的慢性乙型肝炎患者的挽救治疗疗效明显,值得临床推广。Objective This paper evaluated the efficacy of the combined therapy with entecavir （ETV）and adefovir （ADV） in patients with chronic hepatitis B who experienced lamivudine （LAM）-resistance.Methods Sixty-six LAM-resistance patients were randomly divided into two groups.Thiry-six patients who were diagnosed with LAM-resistance chronic hepatitis B（CHB）were assigned as the treatment group and received the combined therapy with ETV plus ADV.Thirty CHB patients receiving the combined therapy with LAM plus ADV were assigned as the control group.The changes of levels of ALT,AST, TBIL,HBV-DNA,HBV serum markers and mutation status before and after 12 and 48 weeks of treatment,as well as the rate of mutations other than that at rtM204I after 48 weeks of treatment,were measured in both groups.Results The levels of ALT and AST in the treatment group [（36.5±13.23）U/L,（50.2 ±11 .66）U/L]were significantly lower than that in the control group [（60.3±12.28）U/L,（69.7±13.56）U/L]in 12 weeks （P 〈0.01）.Similarly,the values of ALT and AST in the treatment group [（27.9 ±10.58）U/L,（26.7 ±10.95 ）U/L]were also lower than that in the control group [（50.4 ± 11 .53）U/L,（44.9±15.33）]in 48 weeks （P 〈0.05）.The rate of undetected serum HBV DNA in two check points （12 and 48 weeks）in the treatment group （85.5% and 91 .7%）was statistically higher than that in the control group （53.3% and 73.3%,both P 〈0.05 ）.However,there was no significant difference in the HBeAg seroconversion rate among HBeAg-positive patients between the two groups.One case of new mutation other than rtM204I was found in the treatment group, while 6 new mutations were detected in the control group （χ2 =5.12,P =0.024）.Conclusion The combined therapy with ETV and ADV has critical therapeutic effect in treating LAM-resistant CHB patients,and the present clinical application is highly recommended.

关 键 词：慢性乙型肝炎 恩替卡韦 阿德福韦酯 拉米夫定 联合治疗 耐药 

分 类 号：R512.62[医药卫生—内科学]