摘要:目的: 觀察拉米夫定聯合阿德福韋酯治療E抗原陰性的慢性乙型肝炎患者的療效和安全性。 方法 :2006～2007年來我院就診的慢性乙型肝炎患者,給予拉米夫定100 mg/d,阿德福韋酯 100 mg/d,觀察治療前及治療后12、24 及48周谷丙轉氨酶水平、HBV DNA水平、乙型肝炎病毒血清標志物的應答效果及腎功能變化。 結果 :治療12周、24周和48周時,HBV DNA轉陰率分別為17%、43%和87%,且各組間差異具有統計學意義(P lt;005);ALT復常率分別為13%,67%和100%,且各組間差異具有統計學意義(P lt;005);治療48周時,所有患者均未發生表面抗原的消失;整個治療過程中,患者的耐受性良好,未發生一例嚴重不良事件。 結論 :拉米夫定聯合阿德福韋酯治療E抗原陰性的慢性乙肝患者,可獲得較好的臨床療效,該治療策略為臨床抗病毒治療提供了新的選擇。Abstract: Objective: To observe the curative efficacy and safety of lamivudine combined with adefovir dipivoxil on HBeAgnegative initial treated chronic hepatitis B (CHB) patients. Methods : Outatients from our hospital between June, 2006 and August, 2007, who received lamivudine 100 mg and adefovir dipivoxil 10 mg per day were screened. And the level of ALT, HBV DNA, and urea nitrogen, as well as the statue of HBsAg and antiHBs were detected at week 12, 24, and 48 Results : The undetectable rates of HBV DNA were 17%, 43%, and 87% at week 12, 24, and 48 respectively, and the difference in response rate were statistic significantly (Plt;005). The ALT normalization rate were 13%, 67%, and 100% at week 12, 24, and 48 respectively, and the difference in response rate were statistic significantly (Plt;005); During the course of antiviral therapy, the loss of HBsAg was not observed and all patients were well tolerated. Conclusion : The combination of lamivudine and adefovir dipivoxil were effective for HBeAgnegative CHB patients, and this treatment strategy provided us a new option in clinical antiviral practice.
目的探討聯合阿德福韋酯和恩替卡韋比較治療拉米夫定耐藥的HBsAg陽性腎移植患者的療效。 方法納入2007年1月至2012年3月在四川大學華西醫院和三臺縣人民醫院門診或住院經拉米夫定治療后出現耐藥的HBsAg陽性腎移植患者，比較不同隨訪時間下兩組患者肝功能、腎功能及不良反應的差異。統計分析采用SPSS 16.0軟件。 結果共納入15例患者，平均年齡為36.7±6.6歲，男性患者為主。經治療4周、12周、24周、48周、96周，A、B兩組肝功復常率、HBV-DNA載量陰轉率和肌酐水平均無統計學差異（P＞0.05）。 結論HBsAg陽性腎移植患者出現拉米夫定耐藥后采用與阿德福韋酯聯合治療或換用恩替卡韋均可有效抑制乙肝病毒復制，但有部分患者未能達到HBV-DNA載量降至最低檢測值下限的療效；使用阿德福韋酯的部分患者可能會出現肌酐升高；初始即采用高效、對腎功能影響小、低耐藥發生率的抗乙肝病毒治療藥物可能更適合于HBsAg陽性腎移植患者。