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The clinical effect Adefovir dipivoxil in Lamivudine resistant HBeAg positive chronic hepatitis B patients
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摘要: 目的评价阿德福韦酯治疗对拉米夫定耐药的HBeAg阳性慢性乙型肝炎患者的临床疗效。方法 75例对拉米夫定耐药的HBeAg阳性慢性乙型肝炎患者,联合组(48例)加用阿德福韦酯(10 mg/d)治疗48周;单药组(27例)改用阿德福韦酯(10 mg/d)治疗48周,分别检测治疗前及治疗12周、24周和48周时患者血清HBVDNA定量、HBV血清标志物及肝功能。结果治疗48周时,联合组与单药组HBVDNA阴转率分别为62.5%和29.6%(P<0.01),HBeAg阴转率分别为31.3%和11.1%(P<0.05),HBeAg血清转换率为16.7%和7.4%(P>0.05),ALT复常率分别为91.7%和88.9%(P>0.05)。治疗48周无肾脏安全性问题发生。结论加用阿德福韦酯可作为对拉米夫定耐药患者治疗的首选方案之一。Abstract: Objective To evaluate the clinical effect of Adefovir dipivoxil (ADV) therapy in Lamivudine (LAM) resistant HBeAg-positive chronic hepatitis B (CHB) patients.Methods Seventy-five Lamivudine resistant HBeAg-positive CHB patients were divided into two groups: ADV group or ADV combined with LAM group.The clinical data including the levels of serum HBVDNA, HBV markers and ALT measurements were collected at baseline, week 12, week 24 and week 48.Results At the end of treatment patients with undetected HBVDNA level (< 3log10 copy/ml) and HBeAg-negative’ s were 62.5% and 31.3%, 29.6% and 11.1% (P < 0.01) in combined therapy and ADV monotherapy group, respec-tively.The HBeAg seroconversion and the ALT normalization rates were 16.7% and 91.7%, and 7.4% and 88.9% (P > 0.05) in the combined therapy and ADV monotherapy, respectively.No renal toxic effects were observed at the end of study.Conclusion Adefovir dipivoxil and lamivudine combination therapy is effective and safe for Lamivudine resistant CHB patients.
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Key words:
- hepatitis B /
- chronic /
- Lamivudine
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[1]Pepers MG, Hann HW, Martin P, et a1.Adefovir dipivoxil alone or incombination with lamivudine in patients withlamivudine-resistantchronic hepatitis B[J].Gastroenterology, 2004, 126 (1) ∶91-101. [2]中华医学会肝病学分会、感染病学分会.慢性乙型肝炎防治指南[J].中华肝脏病杂志, 2005, 13 (12) ∶881-891. [3]Lee YS, Suh DJ, Lim YS, et a1.Increased risk ofadefovir resistancein patients with lamivudine resistan t chronic hepatitis B after 48weeks of adefovir dipivoxil monotherapy[J].Hepatolgy, 2006, 44 (6) ∶1385-1391. [4]Yeon JE, Too W, Hong SP, et a1.resistance to adefovir dipivoxil inlamivudine resistan t chronic hepatitis B patients treated with addovirdipivoxil[J].Gut, 2006, 55 (10) ∶1488-1495. [5]Rapti I, Dimou E, Mitsoula P, et a1.Adding-on versus switching toadefovir therapy in lamivudine-resistant HBeAg-negative chronichepatitis B[J].Hepatology, 2007, 45 (2) ∶307-313. [6]Perrillo R, Hann HW, Mutimer D, et a1.Adefovir dipivoxil added toongoing lamivudine in chronic hepatitis B with YMDD mutant hepati-tis B virus[J].Gastroenterology, 2004, 126 (1) ∶343-347. -
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