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The efficacy of 3 years adefovir monotherapy in chronic hepatitis B patients with lamivudine resistance
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摘要: 目的总结阿德福韦酯(ADV)单药挽救治疗拉米夫定(LAM)耐药慢性乙型肝炎患者效果,分析疗效影响因素,探讨单药挽救LAM耐药的可行性。方法 60例慢性乙型肝炎应用LAM耐药后入组挽救治疗。收集患者的基本特征:如年龄、性别、肝生化指标、HBV DNA及HBV M。纪录治疗持续时间及应答,并进行分组对照。结果 60例中,HBV DNA定量反弹≥1log10拷贝/ml 20例,HBV DNA测序rtM204I/V、rtL180M位点变异40例。生化学突破的LAM耐药患者,给予ADV单药治疗。完成156周治疗者42例。HBV DNA低复制组(基线水平HBV DNA 103～105拷贝/ml)治疗后第12至156周HBV DNA转阴率均为80.0%,高复制组(基线水平HBV DNA≥106拷贝/ml)转阴率为40.7%～44.7%,两组相比差异有统计学意义(P<0.01)。HBV DNA转阴率随治疗时间延长渐增加。治疗156周时,HBeAg阳性血清学转换率24.1%。4例因检测出rtA181V/I/S位点变异改用恩替卡韦(ETV)。结论 ADV单药挽救治疗LAM耐药慢性乙型肝炎,具有一定的...Abstract: Objective To evaluate the effect of rescue monotherapy of adefovir (ADV) in patients with chronic hepatitis B (CHB) who had developed drug resistance to lamivudine (LAM) and moreover to gain experience of the treatment of LAM resistant.Methods A total of 60 treated CHB patients with LAM resistance were enrolled in the present study.The patients′ baseline characteristics such as age, gender, blood tests and hepatitis B virus (HBV) DNA were collected;therapy duration and the response of each patient were also recorded.Results 20 of 60 cases had HBV DNA quantitative rebound ≥ 1log10copies/ml HBV DNA sequencing rtM204I/V, rtL180M sites of variation were seen in the remaining 40 cases.Biochemical breakthrough was observed in LAM-resistant patients being treated with ADV monotherapy.Completion of 156 weeks of treatment in 42 cases.In low copy HBV DNA group (baseline HBV DNA 103-105 copies /ml) after 12-156 weeks of treatment, HBV DNA negative rates were 80.6%.Whereas in high copy HBV DNA group (baseline HBV DNA≥106 copies /ml) , negative rates were 40.7%-44.7%.The two groups had significant differences (P<0.01) .HBV DNA negative rate gradually increased with prolonged treatment.When the treatment was at 156 week, HBeAg seroconversion rate was 24.1%.Four cases of variant sites detected rtA181V/I/S using ETV.Conclution ADV monotherapy in the treatment of LAM-resistant chronic hepatitis B have certain effect, and is more suitable for patients with low viral load.
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Key words:
- hepatitis B /
- chronic /
- hepatitis B virus /
- lamivudine /
- drug resistance
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[1] 中华医学会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志.2011, 27 (1) 1-16. [2]Chung GE, Kim W, Lee KL, et al.Add-On Adefovir Is Supe-rior to a Switch to Entecavir as Rescue Therapy for Lamivudi-ne-Resistant Chronic Hepatitis B[J].Dig Dis Sci, 2011, 56 (7) :2130-2136. [3]Vassiliadis TG, Giouleme O, Koumerkeridis G, et al.Adefovirplus lamivudine are more effective than adefovir alone inlamivudine-resistant HBeAg-chronic hepatitis B patients:a 4-year study[J].J Gastroenterol Hepatol[J].2010, 25 (1) :54-60. [4]Kim HJ, Park JH, Park DI, et al.Rescue therapy for lamivudi-ne-resistant chronic hepatitis B:comparison between ente-cavir 1.0 mg monotherapy, adefovir monotherapy and adefo-vir add-on lamivudine combination therapy[J].J Gastroen-terol Hepatol, 2010, 25 (8) :1374-13 80. [5]Liu Y, Wang C, Zhong Y, et al.Evolution and suppression ofHBV strains with multidrug resistance to lamivudine, adefovirdipivoxil and entecavir in a patient with chronic hepatitis B[J].Antivir Ther, 2010, 15 (8) :1185-1190. [6]Shin SR, Koh KC, Gwak GY, et al.A low viral load predicts ahigher initial virologic response to adefovir in patients withLamivudine-resistant chronic hepatitis B[J].Gut Liver, 2010, 4 (4) :530-536. [7]Idilman R, Kaymakoglu S, Oguz Onder F, et al.A short courseof add-on adefovir dipivoxil treatment in lamivudine-resistantchronic hepatitis B patients[J].J Viral Hepat, 2009, 16 (4) :279-285. [8]Okuse C, Yotsuyanagi H, Yamada N, et al.Effect of nucleo-side analog-interferon sequential therapy on patients with a-cute exacerbation of chronic hepatitis B[J].Hepatol Res, 2010, 40 (5) :461-469. [9]Dai CY, Chuang WL, Hsieh MY, et al.Adefovir dipivoxil treat-ment of lamivudine-resistant chronic hepatitis B[J].AntiviralRes, 2007, 75 (2) :146-151. [10]Chen CH, Wang JH, Lu SN, et al Characteristics of adefovirresistance in patients with or without lamivudine-resistanthepatitis B virus treated with adefovir:a 4-year experience[J].Antivir Ther, 2010, 15 (8) :1185-1190. [11]Kim MC, Jung SW, Shin JW, et al.The Level of HBV DNAat Month 12 Is an Important Predictor of Virological Break-through During Adefovir Monotherapy in Chronic Hepatitis BPatients with Lamivudine Resistance[J].Dig Dis Sci, 2011, 56 (4) :1215-1221. -
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