中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2009年
3期
171-174
,共4页
邱源旺%蒋祥虎%黄利华%胡泰洪%丁虹%蒋跃明%戴亚新%周敏
邱源旺%蔣祥虎%黃利華%鬍泰洪%丁虹%蔣躍明%戴亞新%週敏
구원왕%장상호%황리화%호태홍%정홍%장약명%대아신%주민
肝炎,乙型,慢性%治疗%YMDD变异%拉米夫定%阿德福韦酯%恩替卡韦
肝炎,乙型,慢性%治療%YMDD變異%拉米伕定%阿德福韋酯%恩替卡韋
간염,을형,만성%치료%YMDD변이%랍미부정%아덕복위지%은체잡위
Hepatitis B,chronic%Therapy%YMDD mutation%Lamivudine%Adefovir dipivoxil%Entecavir
目的 探讨慢性乙型肝炎患者发生YMDD病毒变异后的治疗策略. 方法 2005年6月-2007年6月在门诊和住院的经拉米夫定治疗后出现YMDD变异的慢性乙型肝炎患者120例,随机分为4组,A组单用阿德福韦酯10 mg/d,治疗48周;B组采用阿德福韦酯10 mg/d,拉米夫定100 mg/d,联合治疗12周,后单用阿德福韦酯10mg/d治疗36周;C组采用阿德福韦酯10mg/d、拉米夫定100mg/d,联合治疗48周;D组接受恩替卡书1 mg/d,治疗48周.根据资料不同,分别采用方差分析、q检验和χ2检验.结果 4组患者治疗12周内ALT水平进一步反弹升高的患者比例分别为30.0%(9/30)、10.0%(3/30)、6.7%(2/30)、10.0%(3/30)(A组与B组、D组间比较χ2=3.750,P=0.053;A组与C组比较χ2=5.455,P<0.05).A组1例患者出现重型肝炎;治疗12周时4组患者YMDD变异株检测阳性率分别为17.2%、0、0、0;治疗48周时4组患者间ALT水平、HBeAg阳性患者血清转换率比较,差异均无统计学意义.C组、D组患者ALT复常率、HBVDNA达到检测水平以下的百分率与A组患者比较,χ2值分别为7.131、5.516、5.260、6.748,P值均<0.05,差异有统计学意义.4组患者的基因型耐药率分别为6.9%(2/29)、6.7%(2/30)、0、0,A组2例耐药患者测序为rtN236T变异,B组rtA181V和rtN236T变异各1例.结论 YMDD变异后采用阿德福韦酯与拉米夫定联合治疗或恩替卡韦治疗更安全有效.
目的 探討慢性乙型肝炎患者髮生YMDD病毒變異後的治療策略. 方法 2005年6月-2007年6月在門診和住院的經拉米伕定治療後齣現YMDD變異的慢性乙型肝炎患者120例,隨機分為4組,A組單用阿德福韋酯10 mg/d,治療48週;B組採用阿德福韋酯10 mg/d,拉米伕定100 mg/d,聯閤治療12週,後單用阿德福韋酯10mg/d治療36週;C組採用阿德福韋酯10mg/d、拉米伕定100mg/d,聯閤治療48週;D組接受恩替卡書1 mg/d,治療48週.根據資料不同,分彆採用方差分析、q檢驗和χ2檢驗.結果 4組患者治療12週內ALT水平進一步反彈升高的患者比例分彆為30.0%(9/30)、10.0%(3/30)、6.7%(2/30)、10.0%(3/30)(A組與B組、D組間比較χ2=3.750,P=0.053;A組與C組比較χ2=5.455,P<0.05).A組1例患者齣現重型肝炎;治療12週時4組患者YMDD變異株檢測暘性率分彆為17.2%、0、0、0;治療48週時4組患者間ALT水平、HBeAg暘性患者血清轉換率比較,差異均無統計學意義.C組、D組患者ALT複常率、HBVDNA達到檢測水平以下的百分率與A組患者比較,χ2值分彆為7.131、5.516、5.260、6.748,P值均<0.05,差異有統計學意義.4組患者的基因型耐藥率分彆為6.9%(2/29)、6.7%(2/30)、0、0,A組2例耐藥患者測序為rtN236T變異,B組rtA181V和rtN236T變異各1例.結論 YMDD變異後採用阿德福韋酯與拉米伕定聯閤治療或恩替卡韋治療更安全有效.
목적 탐토만성을형간염환자발생YMDD병독변이후적치료책략. 방법 2005년6월-2007년6월재문진화주원적경랍미부정치료후출현YMDD변이적만성을형간염환자120례,수궤분위4조,A조단용아덕복위지10 mg/d,치료48주;B조채용아덕복위지10 mg/d,랍미부정100 mg/d,연합치료12주,후단용아덕복위지10mg/d치료36주;C조채용아덕복위지10mg/d、랍미부정100mg/d,연합치료48주;D조접수은체잡서1 mg/d,치료48주.근거자료불동,분별채용방차분석、q검험화χ2검험.결과 4조환자치료12주내ALT수평진일보반탄승고적환자비례분별위30.0%(9/30)、10.0%(3/30)、6.7%(2/30)、10.0%(3/30)(A조여B조、D조간비교χ2=3.750,P=0.053;A조여C조비교χ2=5.455,P<0.05).A조1례환자출현중형간염;치료12주시4조환자YMDD변이주검측양성솔분별위17.2%、0、0、0;치료48주시4조환자간ALT수평、HBeAg양성환자혈청전환솔비교,차이균무통계학의의.C조、D조환자ALT복상솔、HBVDNA체도검측수평이하적백분솔여A조환자비교,χ2치분별위7.131、5.516、5.260、6.748,P치균<0.05,차이유통계학의의.4조환자적기인형내약솔분별위6.9%(2/29)、6.7%(2/30)、0、0,A조2례내약환자측서위rtN236T변이,B조rtA181V화rtN236T변이각1례.결론 YMDD변이후채용아덕복위지여랍미부정연합치료혹은체잡위치료경안전유효.
Objective To explore the strategy for the treatment of chronic hepatitis B with YMDD mutation. Methods A total of 120 chronic hepatitis B patients with YMDD mutation were randomly as-signed into four groups. In group A, patients received adefovir dipivoxil for 48 weeks. In group B, patients received adefovir dipivoxil in combination with lamivudine during the first 12 weeks and adefovir dipivoxil only for the following 36 weeks. In group C, patients received adefovir dipivoxil in combination with lamivudine for 48 weeks. In group D, patients received entecavir for 48 weeks. Results The rate of rebound of alanine aminotransferase (ALT) was 30.0% (9/30), 10.0% (3/30), 6.7% (2/30), 10.0% (3/30) (P<0.05) during the first 12 weeks, and one patient with severe hepatitis was found in group A. The positive rate of YMDD mutation was 17.9%, 0, 0, 0 at week 12. There was no significant difference in the level of ALT and the rate of HBeAg seroconversion after 48-week treatment (P>0.05). At week 48, there was significant difference in the ALT normalization rate and undetectable HBV DNA rate between group C and group A, and also between group D and group A, and the rate of drug resistant genotype was 6.9%, 6.7%, 0, 0. Two patients had rtN236T mutation in group A, and one patients had rtN236T mutation and another one had rtA181V mutation in group B. Conclusion Adefovir dipivoxil in combination with lamivudine or entecavir are safe and effective thera-pies for chronic hepatitis B patients with YMDD mutation.
