CAJ | 학술논문

目的：观察拉米夫定（LAM）与阿德福韦酯（ADV）联合应用和单用ADV治疗LAM耐药HBeAg阳性慢性乙型肝炎患者的疗效及安全性。方法收集2006年1月至2011年12月在本院就诊的LAM耐药HBeAg阳性慢性乙型肝炎患者40例，单药组与联合组各20例，分别以ADV与LAM联合或单用ADV进行治疗。观察治疗24周、48周时的血清HBV DNA水平及转阴率、HBeAg转阴率、ALT复常率以及治疗过程中药物的不良反应和耐药性。组间比较计量资料采用t检验，计数资料采用卡方检验。结果两组患者在性别、年龄、治疗前的HBV DNA及ALT水平上差异均无统计学意义（P＞0．05）；治疗结束时联合组的血清HBV DNA转阴率和ALT复常率分别为90％及95％，而单药组的血清HBV DNA转阴率和ALT复常率分别为60％及65％，两组比较差异有统计学意义（P＜0．05）；治疗结束时联合组血清HBeAg转阴率为45％，单药组为35％，两组比较差异无统计学意义（χ2＝0．417，P＝0.519）。结论 ADV联合LAM或ADV单药治疗LAM耐药HBeAg阳性慢性乙型肝炎患者均有较好的临床疗效，但ADV与LAM联合治疗可提高HBV DNA转阴率及ALT复常率，其安全性良好，值得借鉴。
목적：관찰랍미부정（LAM）여아덕복위지（ADV）연합응용화단용ADV치료LAM내약HBeAg양성만성을형간염환자적료효급안전성。방법수집2006년1월지2011년12월재본원취진적LAM내약HBeAg양성만성을형간염환자40례，단약조여연합조각20례，분별이ADV여LAM연합혹단용ADV진행치료。관찰치료24주、48주시적혈청HBV DNA수평급전음솔、HBeAg전음솔、ALT복상솔이급치료과정중약물적불량반응화내약성。조간비교계량자료채용t검험，계수자료채용잡방검험。결과량조환자재성별、년령、치료전적HBV DNA급ALT수평상차이균무통계학의의（P＞0．05）；치료결속시연합조적혈청HBV DNA전음솔화ALT복상솔분별위90％급95％，이단약조적혈청HBV DNA전음솔화ALT복상솔분별위60％급65％，량조비교차이유통계학의의（P＜0．05）；치료결속시연합조혈청HBeAg전음솔위45％，단약조위35％，량조비교차이무통계학의의（χ2＝0．417，P＝0.519）。결론 ADV연합LAM혹ADV단약치료LAM내약HBeAg양성만성을형간염환자균유교호적림상료효，단ADV여LAM연합치료가제고HBV DNA전음솔급ALT복상솔，기안전성량호，치득차감。
Objective To observe the therapeutic efficacy and safety of adefovir dipivoxil (ADV)alone versus combined with lamivudine (LAM)in the treatment of LAM-resistant HBeAg-positive chronic hepatitis B (CHB).Methods Forty patients with LAM-resistant HBeAg-positive CHB were randomly assigned to monotherapy group (n=20)and combination therapy group (n=20).The monotherapy group received ADV alone,while the combination therapy group received ADV combined with LAM.After 24 and 48 weeks of treatment,se-rum HBV DNA level,undetectable HBV DNA rate,HBeAg loss rate,alanine aminotransferase (ALT)normalization rate,adverse reac-tions,and drug resistance were assessed.The two groups were compared by t-test for continuous data and chi-square test for categorical data.Results There were no significant differences in sex,age,and pretreatment levels of serum HBV DNA and ALT between the two groups (P>0.05).After 48 weeks of treatment,serum undetectable HBV DNA rate and ALT normalization rate for the combination therapy group were 90%and 95%,respectively,significantly higher than those for the monotherapy group (60%and 65%)(P<0.05);there was no significant difference in HBeAg loss rate between the combination therapy group and monotherapy group (45%vs 35%,χ2 =0.417,P=0.519).Conclusion ADV alone or combined with LAMhas good clinical efficacy in the treatment of LAM-resistant HBeAg-positive CHB.However,the combination therapy can increase undetectable HBV DNA rate and ALT normalization rate and has good safety,and it holds promise for clinical application.