| 李红梅，彭忠田，邱红梅，刘书香.阿德福韦酯治疗慢性乙型肝炎疗效观察及病毒P基因区变异分析.[J].中南医学科学杂志.,2011,39(5):556-559. |
| 阿德福韦酯治疗慢性乙型肝炎疗效观察及病毒P基因区变异分析 |
| Clinical Effect of Adefovir Dipivoxil in Treating Chronic Hepatitis B and the P Gene of Hepatitis B Virus Mutation Analysis |
| 投稿时间：2011-04-06 |
| DOI： |
| 中文关键词: 慢性乙型肝炎 阿德福韦酯 拉米夫定 耐药 变异 |
| 英文关键词:Hepatitis B,chronic adeforvir dipivoxil lamivudine drug-resistance mutation |
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| 中文摘要: |
| 目的探讨阿德福韦酯（ADV）治疗慢性乙型肝炎患者的疗效及耐药变异情况。方法89例慢性乙型肝炎患者中，66例为拉米夫定（LAM）耐药变异患者（联合治疗组），接受阿德福韦酯联合拉米夫定治疗；23例为初治患者（ADV组），接受阿德福韦酯单药治疗，两组患者基线特征无差异。检测分析患者血清HBV DNA、ALT、HBeAg的变化，以及用药48～144周时乙肝病毒P基因区变异发生情况。结果用药12周、24周、48周时，HBV DNA阴转率联合用药组分别为39.4%、54.5%、75.8%，ADV组分别为0%、13.0%、47.8%，联合用药组的病毒学应答高于ADV组（P<0.05）；12周、24周时ALT复常率联合用药组与ADV组各为40.9%、59.1%与0%、21.7%，联合用药组的生物化学应答高于ADV组（P<0.05）；48周时联合用药组与ADV组的ALT复常率、HBeAg阴转率差异无统计学意义（P>0.05）。89例患者用药48周、96周、144周病毒变异发生率分别为0%、3.4%、5.6%；B基因型与C基因型患者病毒变异发生率各为8.6%与10.5%，变异率差异无统计学意义（P>0.05）；联合用药组与ADV组病毒变异发生率分别为9.1%与8.7%，变异率差异无统计学意义（P>0.05）。结论阿德福韦酯是治疗慢性乙型肝炎的有效抗病毒药物，且耐药变异率较低，其对拉米夫定耐药变异株的抑制作用强于HBV野毒株；阿德福韦酯联合拉米夫定治疗拉米夫定耐药，能提高抗病毒疗效、不增加耐药突变发生率。 |
| 英文摘要: |
| ObjectiveTo explore the effects of adefovir dipivoxil（ADV） in treating chronic hepatitis B,and virus drug-resistant mutation.MethodsAmong 89 patients with chronic hepatitis B,66 cases were lamivudine-resistant mutation patients (group A),receiving adefovir dipivoxil combined with lamivudine（LAM）therapy,and 23 cases were newly diagnosed patients (group B),receiving adefovir monotherapy.There were no differences in the baseline characteristics between group A and B.Patients were analyzed with HBV DNA,ALT,HBeAg,and the mutations in the P gene of hepatitis B virus(HBV) were detected medication for weeks 48～144.ResultsAt week 12,24 and 48,Serum HBV DNA negative rate was 39.4%,54.5% and 75.8% in group A,0%,13.0% and 47.8% in group B.Virological response was higher in the group A than group B (P<0.05).At week 12 and 24,ALT normalization rate was 40.9% and 59.1% in group A,0% and 21.7% in group B.Biochemical response was higher in the group A than group B (P<0.05).At 48 week,no significant difference was found in Serum HBeAg negative rate and ALT normalization rate between group A and B (P>0.05).Medication for 48,96 and 144 weeks,the virus mutation rates was 0%,3.4% and 5.6%.In genotype B and C,the virus mutation rates were 8.6% vs10.5%,which had no statistic difference (P>0.05).In group A and B,the virus mutation rates were 9.1% vs 8.7%,which had no statistic difference (P>0.05).ConclusionAdefovir dipivoxil is efficacious for chronic hepatitis B,and lower rate of drug-resistant mutation,and the inhibitory effect for lamivudine-resistant mutants is stronger than HBV wild strain.ADV combined with LAM therapy lamivudine resistance can improve the antiviral efficacy,and reduce the incidence of drug-resistance mutations. |
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