阿德福韦酯疗效欠佳的慢性乙型肝炎患者优化联合治疗的疗效分析  

Efficacy of optimized combined ADV and LMV/LdT in chronic hepatitis B patients with a suboptimal virological response to adefovir monotherapy

作　　者：陈应强[1] 李向永[2] 庄海[1] 崇雨田[2] 

机构地区：[1]贵阳医学院附属白云医院肝病科,贵州贵阳550014 [2]中山大学附属第三医院感染科,广东广州510630

出　　处：《中国医院药学杂志》2015年第14期1310-1313,共4页Chinese Journal of Hospital Pharmacy

基　　金：国家"十二五"科技重大专项(编号:2012ZX10004-902)

摘　　要：目的:比较阿德福韦酯(ADV)疗效欠佳患者采取继续ADV治疗与联合拉米夫定(LMV)或替比夫定(LdT)优化治疗的疗效差异,旨在寻求一种优化方案用于治疗阿德福韦疗效欠佳的慢性乙型肝炎患者。方法:将ADV治疗48周后效果欠佳的慢性乙型肝炎患者分为3组:(1)对照组(A组):继续单用ADV10 mg·d-1治疗,(2)ADV联合LMV(B组):ADV10 mg·d-1,LMV100 mg·d-1优化联合治疗,(3)ADV联合LdT((C组):ADV10 mg·d-1,LdT600 mg·d-1优化联合治疗,比较3组研究对象继续治疗96周的疗效差异及不良反应。结果:521例门诊服用ADV10 mg·d-1的患者48周时共出现127例ADV疗效欠佳者,其中对照组34例,观察组B、C分别55例、38例。治疗48周和96周后,观察组(B组和C组)的ALT复常率、HBV DNA降幅平均值、HBV DNA阴转率、病毒学突破率与对照组差异显著;HBeAg/HBeAb血清学转换率与对照组差异不明显。3组患者服药期间耐受性、依从性良好,部分患者出现血清肌酐水平及磷酸肌酸激酶水平轻度升高,但无一例因严重不良反应导致停药。结论:对于ADV单药治疗过程中发生ADV疗效欠佳的患者,ADV联合LMV、ADV联合LdT是两种安全有效的优化联合治疗方案。OBJECTIVE To evaluate efficacy of a new therapeutic strategy of combining Adefovir dipivoxil（ADV）and Lamivudine（LMV）or Telbivudine（LdT）in chronic hepatitis B patients with suboptimal virological response to ADV monotherapy.METHODS Standard patients received ADV monotherapy continuously for another 96 weeks as the control group（group A）,and patients in group B and C were treated with ADV plus LMV or ADV plus LdT,respectively as the optimized combination therapies for another 96 weeks.Serum ALT,TBIL,ALB and HBV DNA were monitored.RESULTS A total of127 patients who showed suboptimal response to ADV were enrolled from521 patients receiving ADV monotherapy for various periods.Numbers of patients in group A,B and C were 34,55 and 38,respectively.After 48-week and 96-week follow up,patients of group B,C and group A had comparable biochemical response（BR）rate.BR rate（normalization of alanine aminotransferase levels）,median decrease in HBV DNA level,virological response（VR）rate,virologic breakthough（VB）and seroconversion rate were not significantly different between3 groups.All patients in3 groups showed good and comparably tolerant and safe data to therapies.Some showed elevated serum CK in 127 patients who showed suboptimal response to ADV monotherapy,all of them returned to normal interval after rest without modification of antiviral strategy.CONCLUSION Optimized combination therapy of ADV plus LMV,and ADV plus LdT may be good choices for chronic hepatitis B patients with suboptimal viological response to ADV monotherapy.

关 键 词：阿德福韦酯 疗效欠佳 联合治疗 优化治疗 

分 类 号：R969[医药卫生—药理学]