替诺福韦酯治疗拉米夫定耐药联合阿德福韦酯效果不佳的临床观察  

Clinical observation on Tenofovir Disoproxil treating the poor effect of Lamivudine resistance combined with Adefovir Dipivoxil

作　　者：刘军英 党殿杰 路振宇[1] 李军[1] 刁淑梅 张丁[1] LIU Junying;DANG Dianjie;LUZhenyu;LI Jun;DIAO Shumei;ZHANG Ding(Department of Liver Diseases,Handan Infectious Diseases Hospital,Hebei Province,Handan056000,China)

机构地区：[1]河北省邯郸市传染病医院肝病科,河北邯郸056000

出　　处：《中国医药导报》2020年第15期127-130,共4页China Medical Herald

基　　金：河北省卫生计生委医学科学研究重点课题计划项目(20181700)。

摘　　要：目的观察富马酸替诺福韦酯(TDF)治疗拉米夫定耐药联合阿德福韦酯效果不佳患者的临床疗效及安全性。方法选取2010年1月~2018年12月河北省邯郸市传染病医院拉米夫定耐药联合阿德福韦酯抗病毒治疗效果不佳的慢性乙型肝炎患者49例,采用随机数字表法分为TDF组30例(替诺福韦酯)和对照组19例(恩替卡韦+阿德福韦酯)。在换用治疗方案后12、24、48周分别检测患者HBV DNA、肾功能、血钙、血磷。比较两组患者治疗后不同时间的效果差异。结果两组治疗后12周,TDF组HBV DNA转阴率显著高于对照组(P<0.05),在治疗后24、48周,TDF组HBV DNA转阴率与对照组比较,差异无统计学意义(P>0.05);在治疗后12、24周,TDF组HBV DNA水平低于对照组(P<0.05),治疗后48周两组HBV DNA水平差异无统计学意义(P>0.05);TDF组在治疗后12、24、48周,HBV DNA水平与治疗前比较均明显下降(P<0.05),对照组治疗后24、48周,HBV DNA水平与治疗前比较有明显下降(P<0.05)。两组患者耐受性均较好,无严重不良反应发生。结论TDF治疗拉米夫定耐药联合阿德福韦酯治疗效果不佳的患者,在短期内可以快速抑制病毒复制,提高HBV DNA转阴率,同时具有很好的安全性。Objective To observe the clinical efficts and safety of Tenofovir Disoproxil Fumarate(TDF)treating the poor effect of Lamivudine resistance combined with Adefovir Dipivoxil.Methods From January 2010 to December 2018,49 patients with chronic hepatitis B with poor effects by Lamivudine resistance combined with Adefovir Dipivoxil,were chosen from the Handan Infectious Diseases Hospital in Hebei Province.Patients were divided into TDF group of 30 cases(Tenofovir Dipivoxil)and the control group of 19 cases(Entecavir combined Adefovir Dipivoxil)by random number table method.After changing the treatment plan,at the 12th,24th and the 48th weeks after treatment,HBV DNA,renal function,blood calcium and phosphorus were tested to compare the treatment effects of the two groups at the above different stages.Results At the 12th week after treatment,the negative conversion rate of HBV DNA in TDF group was significantly higher than that in the control group(P<0.05),at the 24th and the 48th weeks after treatment,there was no significant statistic difference in the negative conversion rate of HBV DNA(P>0.05).At the 12th and the 24th weeks after treatment,the HBV DNA levels in TDF group were significantly lower than those in the control group(P<0.05),at the 48th week after treatment,there was no significant difference in HBV DNA level in the two groups(P>0.05).Compared with the pre-treatment level,HBV DNA in TDF group decreased significantly at the 12th,24th and the 48th weeks after treatment(P<0.05),while in the control group,HBV DNA also decreased significantly at the 24th and the 48th weeks after treatment(P<0.05).Both groups had good tolerability without severe adverse reaction.Conclusion For patients with poor efficts of Lamivudine resistance combined with Adefovir Dipivoxil,within a short time TDF can quickly restrain virus replication and improve the negative conversion rate of HBV DNA,meanwhile with good safety.

关 键 词：慢性乙型肝炎 替诺福韦酯 拉米夫定 恩替卡韦 阿德福韦酯 

分 类 号：R512.6[医药卫生—内科学]