中国药房2017，Vol.28Issue(29)：4037-4041,5.DOI:10.6039/j.issn.1001-0408.2017.29.02
拉米夫定联合阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎患者的疗效及其与HBV基因型的相关性
Therapeutic Efficacy of Lamivudine Combined with Adefovir Dipivoxil in the Treatment of Lamivudine-re-sistant Chronic Hepatitis B Patients and Its Relationship with HBV Genotype
摘要
Abstract
OBJECTIVE:To evaluate therapeutic efficacy of lamivudine(LAM)combined with adefovir dipivoxil(ADV) in the treatment of LAM-resistant chronic hepatitis B patients,and to study the relationship of therapeutic efficacy with hepatitis B virus(HBV)genotype. METHODS:A total of 101 LAM-resistant chronic hepatitis B patients selected during Dec. 2012 to Dec. 2014 were given LAM+ADV for 24 months at least. Regular outpatient visits or telephone follow-up were also performed. Polymerase chain reaction-reverse dot blot method was used to determine the HBV genotype. Chi-square test,Kaplan-Meier meth-od and Log-rank test were used to compare the virological response(HBV-DNA clearance rate)and biological response(ALT normalization rate and HBeAg seroconversion rate)among different genotypes at the 6th,12th,18th and 24th month of fol-low-up. RESULTS:The follow-up rate was 100%,without missed follow-up. Two genotypes were detected,including 34 pa-tients(33.7%)with genotype B and 67 patients(66.3%)with genotype C.At each time point mentioned above,the HBV-DNA clearance rates of 101 patients were 34.7%,55.4%,79.2% and 93.1%.At 6th month,HBV-DNA clearance rate and accumula-tive HBV-DNA clearance rate of genotype B were significantly higher than genotype C,with statistical significance(P<0.05). There was no statistical significance in HBV-DNA clearance rates or accumulative HBV-DNA clearance rates between different genotypes at other time points(P>0.05). At each time point mentioned above,ALT normalization rates of 101 patients were 40.6%,69.3%,82.2%,84.2%;there was no statistical significance in ALT normalization rates or accumulative ALT normaliza-tion rates between different genotypes(P>0.05). At each time point mentioned above,the HBeAg seroconversion rates of 101 patients were 10.9%,19.8%,24.8%,29.7%;there was no statistical significance in the HBeAg seroconversion rates or accu-mulative HBeAg seroconversion rates between different genotypes(P>0.05). CONCLUSIONS:LAM combined with ADV is ef-fective for LAM-resistant chronic hepatitis B patients. Moreover,the combination therapy can achieve earlier viological response in patients with genotype B than those with genotype C.关键词
慢性乙型肝炎/拉米夫定/阿德福韦酯/耐药/乙型肝炎病毒基因型/病毒学应答/生化学应答Key words
Chronic hepatitis B/Lamivudine/Adefovir dipivoxil/Drug-resistant/Hepatitis B virus genotype/Virolog-ical responses/Biological response分类
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常彩芳,范敬静,王浩..拉米夫定联合阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎患者的疗效及其与HBV基因型的相关性[J].中国药房,2017,28(29):4037-4041,5.基金项目
河北省医学科学研究重点课题计划项目(No.20150472) （No.20150472）
