目的 評估替比夫定與阿德福韋酯聯合治療優化阿德福韋酯單藥治療應答不佳的陽性慢性乙型肝炎患者的療效。 方法 選擇2008年6月－2009年8月間共26例阿德福韋酯治療至少12個月且病毒學應答不佳的乙型肝炎病毒e抗原（HBeAg），陽性的慢性乙型肝炎患者，在10 mg阿德福韋酯治療的基礎上，加用600 mg替比夫定。肝功能和乙型肝炎病毒（HBV） DNA每3個月評估1次，乙型肝炎兩對半和腹部B型超聲每半年評估1次。 結果 在第1年的治療期間，所有患者血清HBV DNA水平均呈進行性下降，其中24例（92.3%）血清HBV DNA水平在聯合治療12個月時低于檢測值下限，有25例（96.2%）患者丙氨酸轉氨酶水平復常。治療6個月時，分別有7例（26.9%）和2例（7.7%）患者發生HBeAg消失和血清學轉換；治療12個月時，分別有11例（42.3%）和8例（30.8%）患者發生HBeAg消失和血清學轉換。整個治療期間，26例患者均未出現病毒學突破。 結論 阿德福韋酯單藥治療應答不佳時，加用替比夫定可有效控制病毒，使患者獲得較好的病毒學、生化學和免疫學應答。
Objective To evaluate the curative efficacy of telbivudine combined with defovir dipivoxil on positive-HBeAg chronic hepatitis B patients with suboptimal response to adefovir dipivoxil. Methods A total of 26 HBeAg-positive patients with suboptimal response to adefovir dipivoxil (treated with adefovir dipivoxil for more than 12 months) were treated with adefovir dipivoxil 10 mg in addition to telbivudine 600 mg between June 2008 and August 2009. Liver function and serum hepatitis B virus (HBV) DNA tests were assessed at the baseline and 3-month intervals, whereas HBV serological markers and abdominal ultrasonography were carried out every 6 months. Results During the first year of treatment, all patients showed a progressive decline of serum HBV DNA levels; while undetectable serum HBV DNA and normalization of alanine aminotransferase was achieved in 24(92.3%) and 25 (96.2%) patients, respectively, at the end of the first year of treatment. The 6- and 12-month cumulative rates of HBeAg loss were 26.9% (7/26) and 42.3% (11/26), respectively; and corresponding cumulative rates of HBeAg/anti-HBe seroconversion were 7.7% (2/26) and 30.8 (8/26), respectively. During the observation period, no virological breakthrough was detected. Conclusion Telbivudine combined with defovir dipivoxil may be a good choice for patients with suboptimal response to adefovir dipivoxil, which could induce effective viral inhibition and help patients obtain more virological, biochemical and immunological responses.
引用本文： 劉鋒,朱利紅,孔亞蘭,賈彬. 替比夫定聯合阿德福韋酯治療阿德福韋酯應答不佳的乙型肝炎病毒e抗原陽性慢性乙型肝炎患者. 華西醫學, 2012, 27(1): 10-13. doi: CNKI: 51-1356/R.20120115.1541.004 復制