Observation of long-term efficacy of different treatment protocol of Adefovir dipivoxil in chronic hepatitis B patients with Lamivudine-resistance
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摘要: 目的观察不同方法阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎(CHB)长期疗效。方法 63例服用拉米夫定耐药的代偿期CHB患者,随机分为两组。A组,无限期拉米夫定联合阿德福韦酯治疗,6个月之内,HBV DNA下降2 log10或病毒检测不到者继续观察。B组,拉米夫定联合阿德福韦酯3~6个月,HBV DNA下降2 log10或病毒检测不到,停拉米夫定,单用阿德福韦酯,继续观察。所有患者定期检测肝功能,每3个月检测HBV DNA,每半年检测拉米夫定耐药位点(rtA173T/V和rtL180M)及阿德福韦酯耐药位点(rtA181T/V和tN236T)。结果 A组在防止再次乙型肝炎病毒(HBV)耐药的发生及预防病毒学和生化学突破要明显优于B组。结论无限期拉米夫定联合阿德福韦酯治疗能明显降低再次HBV耐药的发生,预防病毒学和生化学突破。Abstract: Objective To evaluate the long-term efficacy of different treatment protocol of Adefovir dipivoxil in chronic hepatitis B patients with Lamivudine-resistance.Methods 63 chronic hepatitis B patients with Lamivudine-resistance and compensated liver function were enrolled and were randomly divided into group A and group B.In group A, indefinite Lamivudine in combination with Adefovir dipivoxil was given, and the treatment was continued in patients with reduced serum HBV DNA level greater than 2 log10 or the serum HBV DNA being below the detectable level for 6 months.In group B, lamivudine was given in combination with Adefovir dipivoxil in the first 3-6 months, then the monotherapy of Adefovir dipivoxil was continue in the cases with reduced serum HBV DNA level greater than 2 log10 or the serum HBV DNA becoming undetected.In all the patient, the liver function test was performed periodically, the serum HBV DNA was detected every 3 months, Lamivudine resistance mutations (rtA173T/V and rtL180M) and Adefovir dipivoxil resistance mutations (rtA181T/V and tN236T) were tested every 6 months.Results Group A is superior to group B in preventing further drug-resistance of hepatitis B virus and the following virological and biochemical breakthrough.Conclusion Therapy of indefinite Lamivudine in combination with Adefovir dipivoxil can prevent further drug-resistance of hepatitis B virus and the following virological and biochemical breakthrough.
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Key words:
- hepatitis B /
- chronic /
- Lamivudine /
- drug resistance /
- viral
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