摘要
目的比较拉米夫定（LAM）耐药的HBeAg阳性慢性乙型肝炎患者换用和联用阿德福韦酯（ADV）的疗效。方法172例LAM耐药患者分为2组，116例给予ADV（10mg／d）治疗（换用ADV组），56例给予ADV（10mg／d）联合LAM（100mg／d）治疗（联用ADV组），换用组中疗效欠佳者40例，改为ADV（10mg／d）联合LAM（100mg／a）（后联用组）治疗。每3个月检测肝功能、HBeAg、抗HBe、HBsAg、抗HBs、HBVDNA。结果完全病毒学应答率联用组为66．1％，换用组为45．7％，两组比较差异有统计学意义（x^2=5．075，P〈0．05），后联用组为60．0％，后联用组与联用组相比无统计学差异（70=0．371，P〉0．05）；原发性治疗失败率联用组为7．1％，换用组为22．4％，两组比较差异有统计学意义（x^2=6．116，P〈0．05），后联用组为12．5％，后联用组与联用组之间无统计学差异（70=0．788，P〉0．05）。结论联用ADV组完全病毒学应答率明显优于换用ADV组。换用ADV疗效欠佳者，重新采用LAM＋ADV联合也是一种挽救治疗的方法。应根据早期病毒学应答情况进行优化治疗。
Objective To compare the lamivudine （LAM） combined with adefovir dipivoxil （ADV） therapy and switching to ADV monotherapy in LAM-resistant chronic hepatitis B patients with HBeAg-positive. Methods A total of 172 LAM-resistant patients were randomly divided into 2 groups, 116 cases received ADV （10 rag/d） therapy （switching to ADV group）, 56 cases received LAM （100 rag/d） combined with ADV （10 rag/d） therapy （combined with ADV group）, 40 cases with poor efficacy in switching to ADV group received LAM （100 mg/d） combined with ADV （10 mg/ d） therapy（re-combirmtion group）. The liver function and the levels of HBeAg, anti-HBe, HBsAg, anti-HBs and HBV DNA were tested once every 3 months. Results The complete virologic response rate of combination group was 66.1%,switching group was 45.7%, re-combination was 60.0%, the difference between combinalion with ADV group and switching to ADV group was statistically significant （X2 = 5.075, P 〈 0.05）, while there was no difference between re- combination group and combination group（ ;（2 = 0.371, P 〉 0.05） ; the primary treatment failure rate of combination group was 7.1%, switching group was 22.4%, the difference between combinalion with ADV group and switching to ADV group was statistically significant （x^2 = 6.116, P 〈 0.05）, and there was no difference between re-combination and combination group（x^2 = 0.788, P 〉 0.05）. Conclusions Completely virological response rate of combination ADV group is significantly higher than switching to ADV group. When some patients in switching to ADV group get poor ettica- cy, re-LAM ＋ ADV combination is also a method of salvage therapy. To optimize the treatment should be based on the early virological response.
出处
《国际流行病学传染病学杂志》
CAS
2013年第2期98-101,共4页
International Journal of Epidemiology and Infectious Disease
关键词
肝炎
乙型
慢性
拉米夫定
阿德福韦酯
联合治疗
Hepatitis B, chronic
Lamivudine
Adefovir dipivoxil
Combination therapy
