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A study on the disease progression of chronic Hepatitis B with YMDD variation and its clinical management
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摘要: 目的研究经拉米夫定（LAM）治疗出现YMDD变异且HBeAg（+）的慢性乙型肝炎患者病情的进展及预后;观察阿德福韦酯（ADV）的临床疗效。方法将60例患者随机分为两组,治疗组采用ADV与LAM联合治疗12周,后单用ADV治疗36周;对照组继续LAM并加强护肝治疗48周。结果YMDD变异后大部分患者HBVDNA的反弹和/或ALT的升高程度低于治疗前水平,少数出现轻度黄疸,临床表现轻微;两组治疗48周后ALT水平下降均显著,ADV组比对照组ALT水平、ALT复常率、HBV DNA转阴率差异显著（P≤0.001）;结论ADV治疗YMDD变异,可获得较好的临床疗效。Abstract: Objective To study the disease progression and prognosis among patients with chronic hepatitis B who had hepatitis virus (HBV) DNA YMDD variation after the treatment of lamivudine (LAM) , and to evaluate the efficacy of adefovir dipivoxil (ADV) in the treatment of chronic hepatitis B (CHB) with YMDD variation.Methods We randomly assigned 60 patients into two groups.In ADV group, patients received ADV in combination with LAM during the first 12-week period and in the second period, all the patients were singly received ADV for 36 weeks.But in the control group, patients continued receiving LAM with the addition of drug of protecting liver for 48 weeks.Results Most patients had HBV DNA breakthrough and/or ALT elevation after YMDD variation and the level of HBV DNA and ALT was under baseline level.A few of them had mild jaundice.The clinical manifestation were mild in all patients.The level of ALT reduced remarkably after 48-weeks treatment in two groups.At week 48, there was significance difference between the two groups in the ALT level, ALT normalization rate, HBV DNA negative rate (P<0.001) .Conclusion ADV is an effective medication for treating patients who had YMDD variation.
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Key words:
- chronic hepatitis B /
- YMDD variation /
- lamivudine /
- adefovir dipivoxil
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