YMDD变异后HBeAg（+）患者病情进展及处理的临床研究

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.