目的 对于干扰素治疗无效、核苷类似物耐药后停用抗病毒药物治疗的慢性乙型肝炎患者,探讨其停药的后果及再联合应用核苷类似物长期治疗的必要性.方法 先后用干扰素α-2b、核苷类似物抗病毒治疗均无效的42例慢性乙型肝炎患者,其自动停用抗病毒药物一段时间后,再联用拉米夫定(100 mg/d)(或替比夫定600 mg/d、恩替卡韦0.5 mg/d)与阿德福韦酯(10 mg/d),观察再治疗前后5年患者临床症状体征、生化指标、病毒学、B超半定量肝纤维化积分改变情况.结果 42例患者在抗病毒治疗停止后一段时间内均出现不同程度肝功能损害、生化改变以及肝纤维化积分增加,19%出现肝功能失代偿.而患者采用联合抗病毒治疗后肝功能生化指标正常或好转,病情缓解稳定,生活质量改善,HBV DNA下降>2 log10/mL, 肝纤维化积分下降.结论 慢性乙型肝炎患者干扰素治疗无效、核苷类似物耐药后,停用抗病毒药物会加剧病情进展风险,坚持联合抗病毒治疗可能阻止或延缓病情进展.%Objective To evaluate the clinical risk of patients with chronic hepatitis B(CHB) who stop antiviral therapy and identify the significance of sustained combination therapy with nucleoside/tide analogues. Methods Fortytwo CHB patients treated with invalid interferon alpha and nucleoside/tide analogues were received two kinds of nucleoside/tide analogues (adefovir dipivoxil 10 mg/d and lamivudine 100 mg/d or telbivudine 600 mg/d or entecavir 0.5 mg/d for two years). The risk of stopping antiviral therapy and efficacy of sustained combination with nucleoside/tide analogues were assessed based on the clinical presentation, biochemical response, virology response and ultrasonic semiquantitative scoring for quantitating liver fibrosis for five years. Results After stopping antiviral drugs for a few months ,all of 42 patients were deteriorated in liver function, presenting increased biochemical and elevated ultrasonic semiquantitative score for liver fibrosis, and 19％ of patients developed decompensated liver function. After combination treatment for the patients with nucleoside/tide analogues for two years, all the situation improved, including life quality,ultrasonic semi-quantitative score for liver fibrosis liver function and the level of HBV DNA. Conclusion These results indicate that stopping antiviral therapy for patients with CHB might increase the risk of exacerbation for liver function.However, combination treatment with nucleoside/tide analogues may improve liver function and life quality, delay exacerbation.
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