Objective To evaluate the response level of the treatment,which combines adefovir dipivoxil with lamivudine in the chronic hepatitis B(CHB) patients with mitial poor response to monotherapy with adefovir dipivoxil. Methods 54 CHB patients who were treated alone with adefovir dipivoxil 10 mg a day for 24 weeks and HBV DNA≥104 copies/mL and ALT and did not return to normal, were treated with adefovir dipivoxil and lamivudine. We detected virologic response rates, ALT normalization rates and seroconversion rates in 12 weeks, 24 weeks and 48 weeks. Results Virologic response rates with the combination therapy in HBeAg-positive patients at 12 weeks,24 weeks and 48 weeks, (HBV DNA ≤103 copies/mL)were 15.8％ ,47.4％ and 89.5％ respectively, ALT normalization rates were 13. 2％,42. 1％ and 94. 7％,seroconversion rates were 2. 6％,5. 3％ and 10. 5％. In HBeAg-negative patients, the virologic response rates were 18.8 ％, 37. 5 ％ and 75.0 ％ respeairely, and normalization rates were 25.0％ ,31.3％ and 68.8％ respetively. Conclusion The vinlogical response rate and ALT normahization rate can be imporouted by adcfovir dipcvoxit combcied with eamivudcne in the patiends treated with only ade form dipevoxit .%目的 评估慢性乙型肝炎(CHB)患者初始单药阿德福韦酯治疗应答不佳后加用拉米夫定的应答水平.方法 选择2008年1月至2010年12月在该院门诊治疗的CHB患者54例,均为经阿德福韦酯10 mg单药治疗24周而HBV DNA≥104copy/mL和ALT未恢复正常的CHB患者,采用阿德福韦酯10 mg加拉米夫定100 mg联合治疗,以联合治疗起始点作为基线,并在治疗12、24和48周分别检测肝功能、乙型肝炎标志物6项、HBV DNA定量等指标和不良反应.结果 联合治疗在12、24和48周HBeAg阳性患者病毒学应答率(HBV DNA≤103copy/mL)分别是15.8%、47.4%和89.5%,ALT恢复正常率分别是13.2%、42.1%和94.7%,血清学转换率分别是2.6%、5.3%和10.5%.HBeAg阴性患者病毒学应答率(HBV DNA≤103copy/mL)分别是18.8%、37.5%和75.0%,ALT恢复正常率分别是25.0%、31.3%和68.8%.结论 阿德福韦酯单药治疗应答不佳的CHB患者加用拉米夫定治疗可以明显提高病毒学应答率和ALT恢复正常率.
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