Treatment of chronic hepatitis B with Adefovir dipivoxil:A 3 years observation of clinical efficacy and drug resistance
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摘要: 目的了解阿德福韦酯治疗慢性乙型肝炎临床疗效及耐药临床表现。方法将观察组分为HBeAg阳性组108例,HBeAg阴性组55例,按时间点观察肝生化指标、HBV DNA及HBVM。对治疗无效及HBV DNA反弹≥1log10拷贝/ml病例行病毒基因及耐药突变核酸扩增荧光定量测序检测。结果HBeAg阳性及阴性2组病例,HB-VDNA转阴率均于48周时达顶峰。分别为70.7%、77.7%。HBeAg转阴及抗-HBe阳转率在HBeAg阳性组则逐年上升。144周时达37.5%/25.0%,而2组HBV DNA转阴率144周时均有所下降。HBeAg阴性组HBV DNA转阴率下降了40.0%,下降幅度远大于HBeAg阳性组的9.4%,P<0.01。按终点治疗标准停药或未按终点治疗标准停药者,分别为12例及4例,均于停药后24周内复发。19例肝硬化患者中有7例(36.8%)于治疗48周内发生肝癌、慢性肝衰竭。HBeAg阴性肝硬化起始治疗时,HBV DNA≥105拷贝/ml者,占不良预后中的71.4%。治疗无效/反弹7例,其中2例HBV DNA反弹≥102拷贝/ml及1例治疗96W无效病例,均未发现基...Abstract: Objective To investigate the effect and drug resistance patterns of Adefovir dipivoxil in the treatment of chronic hepatitis B (CHB) .Methods CHB patients were divided in to HBeAg positive (n=108) and HBeAg negative (n=55) groups.The liver function tests, HBVDNA and HBVM were analyzed during the treatment.The virus resistance mutation gene and nucleic acid amplification were performed by fluorescence quantitative sequencing in ineffective patients or patients with HBVDNA rebound ≥1 log10copies/ml.Results HBVDNA negativity reached its peak at the 48th week of treatment in HBeAg positive and HBeAb negative groups with a rate of 70.7% and 77.7% , respectively.HBeAg negativity and anti-HBe seroconversion rates were 37.5% and 25.0% , respectively in HBeAg-positive group and the rate was increased year by year.The HBVDNA negativity decreased at 144th week in both groups and the decrease in HBVDNA negativity in HBeAg negative group (40.0% ) was more than the HBeAg-positive group (9.4% ) (P < 0.01) .24 weeks after cessation of treatment, 12 and 4 patients with or without standard treatment, respectively were showed recurrence.From the total of 19 patients with liver cirrhosis, seven patients (36.8% ) developed liver cancer and chronic liver failure within 48 weeks of treatment.71.4% of HBeAg-negative cirrhosis patients with HBVDNA≥105copies/ml before treatment had poor prognosis.During the treatment, 7 cases were shown rebound in which HBVDNA rebound was≥102copies/ml in two of the cases and 96W mutations were found in one patient.Two cases of rtA181IV and rtN236T mutations were found of which one had a short-term drug history.Another two cases of rtL180M and rtM204I/rtT184A mutations were found with a previous history of treatment with LAM, LdT and ETV.Conclusion Dipivoxil for the treatment of the Arab-Israeli group HBVDNA negative response rate up to the summit in the 48th week, HBeAg negative and positive 3 years showed an upward trend year after year.The end of the standard drug treatment and not following the end standard drug treatment time for a similar rebound in viral genes.Anti-Hbe positive cases of liver cirrhosis HBVDNA≥105copies/ml deterioration 1 year after treatment the proportion of large.HBVDNA increased to ≥1log10copies/ml as clinical indicators in line with the virus rebound is not high.
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Key words:
- Adefovir /
- Chronic Hepatitis B /
- Resistance
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