中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2013年
3期
153-156
,共4页
陈仁芳%郑毓芳%徐淑凡%杨琦恩%陆宇红%蒋亦明
陳仁芳%鄭毓芳%徐淑凡%楊琦恩%陸宇紅%蔣亦明
진인방%정육방%서숙범%양기은%륙우홍%장역명
获得性免疫缺陷综合征%肝炎,乙型%替诺福韦%拉米夫定
穫得性免疫缺陷綜閤徵%肝炎,乙型%替諾福韋%拉米伕定
획득성면역결함종합정%간염,을형%체낙복위%랍미부정
Acquired immunodeficiency syndrome%Hepatitis B%Tenofovir%Lamivudine
目的 评估基于替诺福韦(TDF)初始联合拉米夫定(LAM)的高效抗反转录病毒治疗(HAART)艾滋病合并乙型肝炎病毒(HBV)感染的疗效及安全性.方法 选取2009年1月至2012年12月在无锡市第五人民医院和上海市公共卫生临床中心门诊治疗或住院的60例合并HBV感染的艾滋病患者.采用数字表法随机将60例患者分为2组:30例接受TDF和LAM联合治疗(TDF+LAM组),30例接受LAM治疗(LAM组),疗程均为72周.所有患者在抗HBV治疗的同时接受HAART.应用SPSS 17.0软件比较两组治疗12,24,48和72周时的肝功能、病毒学应答、血清学应答、HIV RNA转阴率和CD4+T淋巴细胞计数,监测耐药和不良反应.结果 治疗24,48和72周,TDF +LAM组的ALT复常率为83.3％,90.0％和93.3％,优于LAM组(x2=5.079,4.812和5.455,P ＜0.05).治疗48周,TDF+ LAM组有28例(93.3％)患者CD4+T淋巴细胞计数上升≥150个/μL与LAM组(21/30,70.0％)比较差异具有统计学意义(x2=5.455,P＜0.05).治疗12,24,48和72周,TDF+ LAM组的HBV DNA转阴率为60.0％,90.0％,93.3％和96.7％,均高于LAM组(x2=4.800,5.963,5.455和9.017,P＜0.05).TDF+ LAM组未出现HBV耐药及严重不良反应.结论 对于合并HBV感染的艾滋病患者,TDF和LAM初始联合的HAART治疗方案可有效抑制HBV复制,促进肝功能的恢复,降低或延缓HBV耐药的发生,促进CD4+T淋巴细胞的恢复,且安全性良好.
目的 評估基于替諾福韋(TDF)初始聯閤拉米伕定(LAM)的高效抗反轉錄病毒治療(HAART)艾滋病閤併乙型肝炎病毒(HBV)感染的療效及安全性.方法 選取2009年1月至2012年12月在無錫市第五人民醫院和上海市公共衛生臨床中心門診治療或住院的60例閤併HBV感染的艾滋病患者.採用數字錶法隨機將60例患者分為2組:30例接受TDF和LAM聯閤治療(TDF+LAM組),30例接受LAM治療(LAM組),療程均為72週.所有患者在抗HBV治療的同時接受HAART.應用SPSS 17.0軟件比較兩組治療12,24,48和72週時的肝功能、病毒學應答、血清學應答、HIV RNA轉陰率和CD4+T淋巴細胞計數,鑑測耐藥和不良反應.結果 治療24,48和72週,TDF +LAM組的ALT複常率為83.3％,90.0％和93.3％,優于LAM組(x2=5.079,4.812和5.455,P ＜0.05).治療48週,TDF+ LAM組有28例(93.3％)患者CD4+T淋巴細胞計數上升≥150箇/μL與LAM組(21/30,70.0％)比較差異具有統計學意義(x2=5.455,P＜0.05).治療12,24,48和72週,TDF+ LAM組的HBV DNA轉陰率為60.0％,90.0％,93.3％和96.7％,均高于LAM組(x2=4.800,5.963,5.455和9.017,P＜0.05).TDF+ LAM組未齣現HBV耐藥及嚴重不良反應.結論 對于閤併HBV感染的艾滋病患者,TDF和LAM初始聯閤的HAART治療方案可有效抑製HBV複製,促進肝功能的恢複,降低或延緩HBV耐藥的髮生,促進CD4+T淋巴細胞的恢複,且安全性良好.
목적 평고기우체낙복위(TDF)초시연합랍미부정(LAM)적고효항반전록병독치료(HAART)애자병합병을형간염병독(HBV)감염적료효급안전성.방법 선취2009년1월지2012년12월재무석시제오인민의원화상해시공공위생림상중심문진치료혹주원적60례합병HBV감염적애자병환자.채용수자표법수궤장60례환자분위2조:30례접수TDF화LAM연합치료(TDF+LAM조),30례접수LAM치료(LAM조),료정균위72주.소유환자재항HBV치료적동시접수HAART.응용SPSS 17.0연건비교량조치료12,24,48화72주시적간공능、병독학응답、혈청학응답、HIV RNA전음솔화CD4+T림파세포계수,감측내약화불량반응.결과 치료24,48화72주,TDF +LAM조적ALT복상솔위83.3％,90.0％화93.3％,우우LAM조(x2=5.079,4.812화5.455,P ＜0.05).치료48주,TDF+ LAM조유28례(93.3％)환자CD4+T림파세포계수상승≥150개/μL여LAM조(21/30,70.0％)비교차이구유통계학의의(x2=5.455,P＜0.05).치료12,24,48화72주,TDF+ LAM조적HBV DNA전음솔위60.0％,90.0％,93.3％화96.7％,균고우LAM조(x2=4.800,5.963,5.455화9.017,P＜0.05).TDF+ LAM조미출현HBV내약급엄중불량반응.결론 대우합병HBV감염적애자병환자,TDF화LAM초시연합적HAART치료방안가유효억제HBV복제,촉진간공능적회복,강저혹연완HBV내약적발생,촉진CD4+T림파세포적회복,차안전성량호.
Objective To evaluate the efficacy and safety of de novo combination of tenofovir (TDF) plus lamivudine (LAM) based highly active antiretroviral therapy (HAART) for HBV-HIV coinfected patients.Methods Sixty patients with HBV-HIV co-infections admitted to Wuxi Fifth People's Hospital and Shanghai Public Health Clinical Center during January 2009 and December 2012 were enrolled.The patients were randomly divided into TDF + LAM based HAART group (TDF + LAM group,n =30) and LAM based HAART group (LAM group,n =30).All patients were treated for 72 weeks.SPSS 17.0 was used to compare the ALT normalization rate,HBV DNA negative conversion rate,serological response,HIV RNA negative conversion rate and CD4 + lymphocyte counts elevation rate between two groups at 24-,24-,48-and 72-week.Drug resistance and adverse reaction were observed.Results ALT normalization rates in TDF + LAM group at 24-,48-and 72-week were 83.3％,90.0％ and 93.3％,respectively,which were higher than those in LAM group (x2 =5.079,4.812 and 5.455,P ＜0.05).After 48 weeks of treatment,there were 28 patients (93.3％) in TDF + LAM group with the elevation of CD4 + lymphocyte counts ≥ 150 cells/μL,the rate was higher than that in LAM group (21/30,70.0％) (x2 =5.455,P ＜ 0.05).HBV DNA negative conversion rates in TDF + LAM group at 12-,24-,48-and 72-week were 60.0％,90.0％,93.3％ and 96.7％,respectively,which were higher than those in LAM group (x2 =4.800,5.963,5.455 and 9.017,P ＜0.05).No drug resistance and severe adverse reaction was observed in TDF + LAM group.Conclusion TDF + LAM based HAART is better in HBV viral suppression and liver function normalization,and has lower HBV resistance and higher CD4 + T lymphoeyte counts elevation rate than LAM based HAART for HBV-HIV co-infected patients.
