恩替卡韦联合阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎患者临床疗效观察

摘要

Objective To investigate the efficacy and safety of the combined therapy with different doses of entecavir(ETV) and adefovir dipivoxil (ADV) in patients with lamivudine (LAM)-resistant chronic hepatitis B (CHB).Methods A total of 161 patients with LAM-resistant CHB were randomly divided into three groups.The control group(n =53)patients received the combined therapy with LAM and ADV.The observation group 1(n =56) patients received the combined therapy with 0.5mg ETV and ADV.The observation group 2(n =52) patients received the combined therapy with 1.0mg ETV and ADV.The changes in levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),HBeAg and HBV DNA before and after 12,24,and 48 weeks of treatment,were measured in the three groups.Results The levels of ALT and AST in the two observa-tion groups were significantly lower than those in the control group after 12, 24, and 48 weeks of treatment(P <0.05).There was no significant difference in the HBeAg seroconversion rate among HBeAg-positive patients between the control group and the two observation groups.The serum HBV DNA clearance rates in the two observation groups after 12,24,and 48 weeks of treatment were significantly higher than those in the control group(P <0.05).There was no significant difference in the levels of ALT,AST,HBeAg seroconversion rate and HBV DNA clearance rates between the two observation groups.Conclusion The combined therapy with 0.5mg ETV and ADV has good therapeutic effect in treating LAM-resistant CHB patients in addition to the advantage of lightening the economic burden on patients.Its clinical application is highly recommended.%目的：观察不同剂量恩替卡韦（ETV）联合阿德福韦酯（ADV）治疗拉米夫定（LAM）耐药慢性乙型肝炎患者（CHB）的临床疗效和安全性。方法将161例 LAM 耐药 CHB 患者随机分成3组：对照组53例应用 LAM 联合ADV 挽救治疗，观察1组56例应用0．5 mgETV 联合 ADV 治疗，观察2组52例应用1．0 mg ETV 联合 ADV 治疗。观察治疗前及治疗12、24、48周后3组患者血清肝功能指标（ALT 和 AST）、HBeAg 和 HBV DNA 水平的变化。结果治疗后12、24、48周，两个观察组 ALT 和 AST 改善情况明显优于对照组（P ＜0．05）；两个观察组 HBeAg 阳性患者阴转率与对照组比较无统计学意义；两个观察组 HBV DNA 转阴（低于检测下限）率与对照组比较，具有统计学意义（P ＜0．05）。两个观察组之间比较，治疗12、24、48周后 ALT 和 AST、HBeAg 阳性患者阴转率和 HBV DNA 转阴率均无显著性差异。结论0．5 mg ETV 联合 ADV 治疗 LAM 耐药的 CHB 患者的疗效确切而且能够减轻患者经济负担。