国际流行病学传染病学杂志
國際流行病學傳染病學雜誌
국제류행병학전염병학잡지
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY AND INFECTIOUS DISEASE
2008年
5期
301-303
,共3页
邱源旺%蒋祥虎%黄利华%顾锡炳%胡泰洪%吴航源
邱源旺%蔣祥虎%黃利華%顧錫炳%鬍泰洪%吳航源
구원왕%장상호%황리화%고석병%호태홍%오항원
肝硬化%YMDD变异%拉米夫定%阿德福韦酯
肝硬化%YMDD變異%拉米伕定%阿德福韋酯
간경화%YMDD변이%랍미부정%아덕복위지
Liver cirrhosis%YMDD mutation%Lamivudine%Adefovir dipivoxil
目的 评价经拉米夫定(LAM)治疗后出现YMDD变异的代偿期乙型肝炎肝硬化患者采用阿德福韦酯(ADV)单药或与LAM联合治疗的疗效及不良事件发生率.方法 将66例患者随机分为3组,A组采用ADV治疗48周,B组采用ADV与LAN联合治疗12周后,再用ADV治疗36周;C组采用ADV与IAN联合治疗48周.结果 3组治疗12周内出现ALT水平进一步反弹率分别为33.3%(8/24)、5.0%(1/20)和4.5%(1/22)(P<0.05),其中A组2例患者出现重型肝炎.3组治疗48周ALT水平下降均显著,但3组之间比较差异均无统计学意义(P>0.05);C组ALT复常率、HBV DNA转阴率与A、B组相比,差异有统计学意义(P<0.05),A组与B组之间差异无统计学意义(P>0.05).3组病毒学突破或反弹发生率分别为13.6%、10.0%、0,A组出现rtA181V和rtN236T变异各1例,B组rtN236T变异1例.结论 肝硬化患者出现YMDD变异后采用ADV与LAM联合治疗更安全有效.
目的 評價經拉米伕定(LAM)治療後齣現YMDD變異的代償期乙型肝炎肝硬化患者採用阿德福韋酯(ADV)單藥或與LAM聯閤治療的療效及不良事件髮生率.方法 將66例患者隨機分為3組,A組採用ADV治療48週,B組採用ADV與LAN聯閤治療12週後,再用ADV治療36週;C組採用ADV與IAN聯閤治療48週.結果 3組治療12週內齣現ALT水平進一步反彈率分彆為33.3%(8/24)、5.0%(1/20)和4.5%(1/22)(P<0.05),其中A組2例患者齣現重型肝炎.3組治療48週ALT水平下降均顯著,但3組之間比較差異均無統計學意義(P>0.05);C組ALT複常率、HBV DNA轉陰率與A、B組相比,差異有統計學意義(P<0.05),A組與B組之間差異無統計學意義(P>0.05).3組病毒學突破或反彈髮生率分彆為13.6%、10.0%、0,A組齣現rtA181V和rtN236T變異各1例,B組rtN236T變異1例.結論 肝硬化患者齣現YMDD變異後採用ADV與LAM聯閤治療更安全有效.
목적 평개경랍미부정(LAM)치료후출현YMDD변이적대상기을형간염간경화환자채용아덕복위지(ADV)단약혹여LAM연합치료적료효급불량사건발생솔.방법 장66례환자수궤분위3조,A조채용ADV치료48주,B조채용ADV여LAN연합치료12주후,재용ADV치료36주;C조채용ADV여IAN연합치료48주.결과 3조치료12주내출현ALT수평진일보반탄솔분별위33.3%(8/24)、5.0%(1/20)화4.5%(1/22)(P<0.05),기중A조2례환자출현중형간염.3조치료48주ALT수평하강균현저,단3조지간비교차이균무통계학의의(P>0.05);C조ALT복상솔、HBV DNA전음솔여A、B조상비,차이유통계학의의(P<0.05),A조여B조지간차이무통계학의의(P>0.05).3조병독학돌파혹반탄발생솔분별위13.6%、10.0%、0,A조출현rtA181V화rtN236T변이각1례,B조rtN236T변이1례.결론 간경화환자출현YMDD변이후채용ADV여LAM연합치료경안전유효.
Objective To evaluate the efficacy and adverse events of adefovir dipivoxil (ADV) or in combination with lamivudine(LAM) in the treatment of liver cirrhosis with YMDD mutation. Method 66 patients were randomly assigned into three groups. In group A, patients received ADV for 48 weeks. In group B, patients received ADV in combination with LAM during the first 12-week period and received ADV for 36 weeks only in the second period. In group C, patients received ADV in combination with LAM for 48 weeks. Results The rebound rates of ALT were 33.3 % (8/24), 5.0%(1/20) ,4.5%(1/22) during the first 12-week period in three groups, respectively ( P < 0.05). Two patients appeared severe hepatitis in group A. The level of ALT reduced remarkably in three groups and there was no significant difference between them after 48-week treatment( P > 0. 05). At week 48, there was significant difference between group C and A, and also between groups C and B in the ALT normalization rate and HBV DNA negative rate ( P < 0.05),but there was no significant difference between group A and B. Patients with virological breakthrough or reboundrate were 13.6%, 10.0% ,0 respectively in three groups. One patient had rtA181V mutation and another patient had rtN236T mutation in group A,and one patient in group B had rtN236T mutation. Conclusions ADV in combination with LAM is safe and effective for the liver cirrhosis patients with YMDD mutation.
