【摘要】 目的探讨恩替卡韦联合阿德福韦酯治疗拉米夫定耐药且对序贯阿德福韦酯挽救治疗疗效欠佳的慢性乙型肝炎患者的疗效及安全性。方法对既往存在拉米夫定耐药且对序贯阿德福韦酯疗效欠佳的慢乙肝患者,回顾性分析比较阿德福韦酯联合拉米夫定优化治疗(A组,n=25)和阿德福韦酯联合恩替卡韦优化治疗(B组,n=27)12、24、48周的生化学应答率、病毒学应答率及病毒学突破率。结果两组治疗48周时疗效比较显示,B组治疗48周时ALT复常率为54.5%(6/11),与A组41.6%(5/12)比较,差异无统计学意义(P=0.537);HBV DNA水平为(0.4±1.3)log10IU/ml,与A组(3.5±1.0)log10IU/ml比较,差异有统计学意义(P<0.001);HBVˉDNA不可测率为63.0%(17/27),与A组32.0%(8/25)比较,差异有统计学意义(P=0.026);HBe Ag/HBe Ab血清学转换率为4.2%(1/24),与A组4.2%(1/23)比较,差异无统计学意义(P=0.956);病毒学突破率为0,与A组36.0%(9/25)比较,差异有统计学意义(P=0.001);两组患者服药期间耐受性、依从性良好,3例患者出现轻微不良反应,无1例因严重不良反应导致停药。结论恩替卡韦联合阿德福韦酯对拉米夫定耐药且对序贯阿德福韦酯挽救治疗发生疗效欠佳的慢性乙型肝炎患者,是一种更加安全有效的挽救治疗方案。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of entecavir(ETV) combined with adeforvir(ADV) therapy for chronic hepatitis B patients showing poor efficacy on adefovir salvage therapy and with prior lamivudine resistance. MethodsFifty-two patients with prior lamivudine resistance and showed suboptimal response to adeforvir with HBV DNA ≥ 102 IU/ml after 48 weeks of ADV sequential rescue therapy were selected for this study. ADV combined LAM therapy was continued in 25 patients for another 48 weeks in A group;the other 27 patients were treated with ADV plus ETV for another 48 weeks in B group. The serum ALT,TBIL,ALB,HBV DNA levels were monitored with an interval of 12 weeks. Results After another 48 weeks follow up,the biochemical response(BR) rates(normalization of almandine aminotransferase levels) were 54.5 %(6/11)and 41.6 %(5/12) in A and B groups,respectively,showing no significant differences between two groups(P=0.537);the median HBV-DNA levels of group A and B were(0.4±1.3) and(3.5±1.0)log10 IU/ml,respectively,showing significant differences between two groups(P<0.001);the virological response(VR) rates(HBV-DNA level <102IU/ml) of group A and B were 63.0 %(17/27)and 32.0 %(8/25),respectively,showing significant differences between two groups(P=0.026);the seroconversion rates(from HBe Ag to HBe Ab) of group A and B were 4.2 %(1/24) and 4.2 %(1/23),respectively,showing no significant differences between two groups;the virologic breakthrough(VB) rates of group A and B were 0 and 36.0 %(9/25), respectively,showing significant differences between two groups(P=0.001). Both groups showed comparably tolerant and safe to the therapy. Three patients had a mild adverse reaction without modification of antiviral strategy. Conclusion The therapy of ETV plus ADV is an effective and safe therapeutic strategy for chronic hepatitis B patients with prior LAM resistance and with a suboptimal virological response to ADV.更多还原