【作者】 徐晶； 潘红英； 谌翠容； 金洁； 朱月季； 孙振江； 俞立飞； 卢德荣；

【Author】 The fourth Internal medicine,The sixth people’s hospital of Hang zhou, Hangzhou 310014,China XU Jing PAN Hong-ying CHEN Cui-rong JIN Jie ZHU Yue-ji SUN Zhen-jinang YU Li-fei LU De-rong

【机构】 杭州市第六人民医院内四科；

【摘要】 目的评价并比较拉米夫定和阿德福韦酯三种不同时机联合治疗慢性乙型肝炎48周的疗效。方法将60例慢性乙型肝炎患者分为三组,拉米夫定应答不佳联合阿德福韦酯(A组)、拉米夫定耐药联合阿德福韦酯(B组)及初始拉米夫定联合阿德福韦酯(C组),各20例。分别于治疗12、24、48周时检测HBV DNA、ALT、HBeAg,并于24、48周时对HBV DNA未转阴者行乙肝病毒P区耐药基因测序,评价各组治疗方案的疗效。结果①A、B、C三组患者血清HBV DNA转阴率12周(55%,50%,60%,χ~2=0.404),24周(65%,70%,90%,χ~2=3.733),48周(65%,70%,90%,χ~2=3.733)比较,均无统计学意义(p均>0.05);与0周相比,三组平均HBV DNA载量下降幅度12周(2.16+1.12、2.94+1.39、3.30+1.60log10拷贝/ml,t分别为8.671、9.434、9.236),24周(2.28+1.14、3.36+1.39、3.86+1.46log10拷贝/ml,t分别为8.957、10.801、11.819),48周(2.48+1.14、3.45+1.42、3.85+1.46log10拷贝/ml,t分别为9.706、10.871、11.807)均有统计学意义(p均<0.01)②A、B、C三组患者血清ALT复常率12周(100%,53.6%,66.7%,χ~2=4.056),24周(100%,66.7%,66.7%,χ~2=3.070),48周(100%,77.8%,77.8%,χ~2=1.852)比较,均无统计学意义(p均>0.05);③A、B、C三组患者HBeAg转阴率24周(16.7%,25.0%,33.3%,χ~2=2.679),48周(27.8%,25.0%,33.3%,χ~2=0.960)比较,无统计学意义(p>0.05)。④治疗24、48周时,分别有15、9例患者HBVDNA阳性,YMDD检测均未发现病毒变异。结论①治疗48周,三种联合方案的病毒学、生化学应答效果较好,并获得了一定的血清学应答,未发现病毒基因变异。②三种联合方案48周内的疗效无差异。更多还原

【Abstract】 Objective To investigate the efficacy of three combination therapys with lamivudinevir and adefovir dipivoxil at different times for chronic hepatitis B within 48 weeks.Methods Sixty patients were included in the following three combination treatment groups,group A(n=20):LAM was added to ongoing LAM treatment for LAM-resistant CHB patients;group B(n=20):LAM was added to CHB patients with poor response to LAM monotherapy;group C(n=20):Initial combination therapy of LAM and ADV for patients with CHB.We detected HBV DNA,ALT,HBeAg at week 12,24,48,respectively,and detected HBV mutation for those whose HBV DNA were still positive at week 24,48,respectively.Results There were no statistical significanceof undetected HBVDNA for threegroupsatweekl2(55%,50%,60%,x~2=0.404),week24(65%,70%,9 0%,x~2=3.733),week48(65%,70%,90%,x~2=3.733)(p>0.05);compared with week 0,three groups all had some decrease inHBV-DNAlevelatdifferenttimes,weekl2(2.16+1.12,2.94+1.39,3.30+1.601ogl0copies/ml,t=8.671,9.4 34,9.236),week24(2.28+l.14,3.36+1.39,3.86+1.461ogl0copies/ml,t=8.957,10.801,11.819),week48(2.48+l.14,3 .45+1.42,3.85+1.461ogl0copies/ml,t=9.706,10.871,11.807)(p<0.01);there were no statistical significance for the rate of ALT normalization at week 12(100%,53.6%,66.7%,x~2=4.056),week24(100%,66.7%,66.7%,x~2=3.0 70),week48(100%,77.8%,77.8%,x~2=1.852) for three groups(p>0.05);there were no statistical significance for thelossofHBeAgrateatweek24(16.7%,25.0%,33.3%,x~2=2.679),week48(27.8%,25.0%,33.3%,x~2=0.960)of three groups(p>0.05);15 patients HBV DNA positive at week 24,while 9 at week 48,no HBV mutations were detected of three groups,respectively.Conclusions The three combination therapys all have achieved virolo gical,biochemical,serological response for the duration of 48 weeks and We detected no HBV mutations;The three combination therapys had no difference in efficacy within 48 weeks.更多还原