CAJ | 학술논문

目的：观察早期阿德福韦酯联合拉米夫定治疗拉米夫定应答不佳的HBeAg阳性慢性乙型肝炎（ CHB）的病毒学应答疗效。方法选择经拉米夫定治疗12周内HBV-DNA值下降≤2 Log10拷贝／ml或每月HBV-DNA值下降≤1 Log10拷贝／ml连续两月的HBeAg阳性CHB患者15例，均检测病毒耐药变异并给予阿德福韦酯（10 mg，1次／天）联合治疗。分别观察联合治疗12、24及48周的病毒学应答情况。结果15例患者中11例发生病毒变异，变异发生率73.33％，耐药变异位点以rtM204V／I多见。在联合阿德福韦酯治疗12、24及48周时的HBV-DNA阴转率分别为40％、66.7％及86.7％，在12、48周时差异有统计学意义（P＜0.05）；联合治疗24周及48周时HBeAg阴转率分别为13.3％（2／15）及33.3％（5／15）。结论早期筛选出拉米夫定耐药株并联合阿德福韦酯是对拉米夫定应答不佳CHB患者有效的干预策略之一。
목적：관찰조기아덕복위지연합랍미부정치료랍미부정응답불가적HBeAg양성만성을형간염（ CHB）적병독학응답료효。방법선택경랍미부정치료12주내HBV-DNA치하강≤2 Log10고패／ml혹매월HBV-DNA치하강≤1 Log10고패／ml련속량월적HBeAg양성CHB환자15례，균검측병독내약변이병급여아덕복위지（10 mg，1차／천）연합치료。분별관찰연합치료12、24급48주적병독학응답정황。결과15례환자중11례발생병독변이，변이발생솔73.33％，내약변이위점이rtM204V／I다견。재연합아덕복위지치료12、24급48주시적HBV-DNA음전솔분별위40％、66.7％급86.7％，재12、48주시차이유통계학의의（P＜0.05）；연합치료24주급48주시HBeAg음전솔분별위13.3％（2／15）급33.3％（5／15）。결론조기사선출랍미부정내약주병연합아덕복위지시대랍미부정응답불가CHB환자유효적간예책략지일。
Objective To observe the virological efficacy of adefovir dipivoxil(ADV) combined with lamivudine(LAM) in the treatment of HBeAg positive chronic hepatitis B( CHB) with poor response to lamivudine monotherapy at early stage.Methods We se-lected 15 patients with HBeAg positive CHB patients who were treatment with LAM for less than 12 weeks but HBV-DNA value was de-clined 2 or less Log10 copy/mL or monthly HBV-DNA value was declined 1 or less Log10 copy/mL with two month consecutive HBeAg positive.All 15 patients were tested for resistant HBV variants and received a treatment of combination of ADV(10 mg,a/d) and LAM. Virological response was observed at 12,24 and 48 weeks after treatment.Results Of the 15 patients,there were 11 cases having virus variation.The variation rate was 73.33%.Most resistance mutation sites were found at rtM204V/I.The negative rates of HBV-DNA at end of the 12th,24th and 48th week after the combined treatment were 40%,66.7%and 86.7%,respectively.The difference between the 12th and 48th was statistically significant(P<0.05).The negative rates of HBeAg were 13.3%(2/15)and 33.3%(5/15)at end of the 24th and 48th week after treatment,respectively.Conclusion Early screen of LAM resistance strain and combination of LAM and ADV at early stage can be a good choice for patients with HBeAg positive hepatitis B who have a poor response to LAM monothera-py.