拉米夫定联合阿德福韦酯与换用恩替卡韦单药治疗拉米夫定应答不佳患者的疗效对比

摘要

Objective To evaluate the efficiency of adefovir dipivoxil (ADV) combined with lamivudine (LAM) treatment and entecavir (ETV) monotherapy in chronic hepatitis B (CHB) patients with suboptimal response to LAM.Meathods 80 cases of chronic hepatitis B patients with suboptimal response to LAM were divided into combination treatment group and monotherapy group.The combination group received ADV 10 mg/d and LAM 100 mg/d,the monotherapy group received entecavir 0.5 mg/d,and the efficacy was observed after 48 weeks treatment.Results After 48 weeks treatment,the negative rate of HBV DNA,HBeAg seroconversion rate and ALT recovery rate in combination group were better than those in monotherapy group (90％ vs.70％ ;40％ vs 15％ ;and 95％ vs.80％,respectively).There were no virological breakthrough cases in combination group after 48 weeks treatment,but 2 cases was found in monotherapy group and this 2 cases were ETV resistance.Conclusions Add-on ADV therapy was superior to switch-to ETV monotherapy in CHB patients with suboptimal response to LAM.%目的 观察分别利用拉米夫定和阿德福韦酯联合治疗与换用恩替卡韦单药治疗拉米夫定应答不佳慢性乙型肝炎患者的临床疗效.方法 80例拉米夫定应答不佳的慢性乙型肝炎患者采用随机数字表法分为联合组和单药组,联合组服用拉米夫定100 mg/d和阿德福韦酯10mg/d;单药组服用恩替卡韦0.5 mg/d,观察两组患者治疗48周时的疗效.结果 治疗48周后,联合组的HBV DNA应答率、HBeAg转换率、ALT复常率分别为90.0％、40.0％和95.0％,远高于单药组的70.0％、15.0％和80.0％,两组比较差异均有统计学意义(P＜0.05).治疗48周后,联合组未出现病毒学突破病例;单药组共有2例患者出现病毒学突破.结论 对于拉米夫定应答不佳的慢性乙型肝炎患者,加用阿德福韦酯联合治疗的疗效优于换用恩替卡韦单药治疗,且可降低病毒耐药的发生率.