中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2008年
10期
604-608
,共5页
肝炎,乙型,慢性%拉米夫定%阿德福韦酯
肝炎,乙型,慢性%拉米伕定%阿德福韋酯
간염,을형,만성%랍미부정%아덕복위지
Hepatitis B,chronic%Lamivudine%Adeforvir dipivoxil
目的 探讨拉米夫定耐药慢性乙型肝炎患者改用阿德福韦酯治疗后发生耐药的临床过程及挽救治疗疗效.方法 回顾性分析15例慢性乙型肝炎患者拉米夫定耐药后,在阿德福韦酯单药治疗期间出现的病毒学突破,采用基因测序法检测到HBV聚合酶基因阿德福韦酯相关突变位点,接受挽救治疗措施.结果 15例拉米夫定耐药患者经中位时间为16个月的阿德福韦酯单药治疗,14例出现与阿德福韦酯耐药相关的rtA181T/V和(或)rtN236T突变,1例出现rtM204I+rtL180M+rtA181T联合突变.耐药后15例患者均给予挽救性治疗措施,其中7例接受拉米夫定联合阿德福韦酯治疗的患者,3个月时HBV DNA平均下降(2.2±0.6)lg拷贝/mL,6个月时,5例HBV DNA低于检测限;另3例接受恩替卡韦治疗患者,6个月时HBV DNA水平下降2.8～3.5 lg拷贝/mL.结论 拉米夫定联合阿德福韦酯是拉米夫定耐药慢性乙型肝炎患者改用阿德福韦酯单药治疗发生阿德福韦酯耐药后的有效挽救治疗措施.
目的 探討拉米伕定耐藥慢性乙型肝炎患者改用阿德福韋酯治療後髮生耐藥的臨床過程及輓救治療療效.方法 迴顧性分析15例慢性乙型肝炎患者拉米伕定耐藥後,在阿德福韋酯單藥治療期間齣現的病毒學突破,採用基因測序法檢測到HBV聚閤酶基因阿德福韋酯相關突變位點,接受輓救治療措施.結果 15例拉米伕定耐藥患者經中位時間為16箇月的阿德福韋酯單藥治療,14例齣現與阿德福韋酯耐藥相關的rtA181T/V和(或)rtN236T突變,1例齣現rtM204I+rtL180M+rtA181T聯閤突變.耐藥後15例患者均給予輓救性治療措施,其中7例接受拉米伕定聯閤阿德福韋酯治療的患者,3箇月時HBV DNA平均下降(2.2±0.6)lg拷貝/mL,6箇月時,5例HBV DNA低于檢測限;另3例接受恩替卡韋治療患者,6箇月時HBV DNA水平下降2.8～3.5 lg拷貝/mL.結論 拉米伕定聯閤阿德福韋酯是拉米伕定耐藥慢性乙型肝炎患者改用阿德福韋酯單藥治療髮生阿德福韋酯耐藥後的有效輓救治療措施.
목적 탐토랍미부정내약만성을형간염환자개용아덕복위지치료후발생내약적림상과정급만구치료료효.방법 회고성분석15례만성을형간염환자랍미부정내약후,재아덕복위지단약치료기간출현적병독학돌파,채용기인측서법검측도HBV취합매기인아덕복위지상관돌변위점,접수만구치료조시.결과 15례랍미부정내약환자경중위시간위16개월적아덕복위지단약치료,14례출현여아덕복위지내약상관적rtA181T/V화(혹)rtN236T돌변,1례출현rtM204I+rtL180M+rtA181T연합돌변.내약후15례환자균급여만구성치료조시,기중7례접수랍미부정연합아덕복위지치료적환자,3개월시HBV DNA평균하강(2.2±0.6)lg고패/mL,6개월시,5례HBV DNA저우검측한;령3례접수은체잡위치료환자,6개월시HBV DNA수평하강2.8～3.5 lg고패/mL.결론 랍미부정연합아덕복위지시랍미부정내약만성을형간염환자개용아덕복위지단약치료발생아덕복위지내약후적유효만구치료조시.
Objective To analyze clinical courses and rescue therapies of adefovir-resistant chronic hepatitis B patients who had lamivudine resistance before and then changed to take adefovir dipivoxil. Methods 15 patients resistant to lamivudine were retrospectively analyzed, who had virological breakthrough after adefovir dipivoxil monotherapy and were treated with rescue therapy.Adefovir-resistant mutations were detected by direct sequencing of the HBV polymerase gene. Results 15 patients with former lamivudine resistance were treated with adefovir dipivoxil monotherapy for a median of 16 months, and 14 patients were found adefovir-resistant mutations at rtA181T/V and(or) rtN236T, only 1 patient was found multi-mutations at rtM204I + rtL180M + rtA181T. Rescue therapies were given to all the 15 patients after drug resistance. Among the 7 patients treated with lamivudine in combination with adefovir for 3 months,whose HBV DNA levels decreased (2.2±0.6)lg copy/mL on average, 5 patients achieved HBV DNA undetectable after 6 months combinative therapy. The HBV DNA levels of the 3 patients treated with entecavir decreased 2.8～3.5 lg copy/mL within 6 months treatment. Conclusion These preliminary data suggest the combination of lamivudine and adeforvir dipivoxil may be an effective rescue therapy for adefovir-resistant patients who have former lamivudine resistance.
