Objective To investigate the effect of adefovir dipivoxil combined with interferon on lamivudine-resistant chronic hepatitis B (CHB ). Methods Fifty-three CHB patients with YM -DD mutations were divided into two groups according their wishes .The addition group (n=38) was treated wtih oral lamivudine and adefovir dipivoxil .The combination group (n=15) was given adefovir dipivoxil and interferon .Serum hepatitis B virus (HBV ) DNA and alanine transaminase (ALT ) levels and HBV markers were detected at treatment week 4 ,8 ,12 ,24 ,36 and 48 .Moreover,clinical characteristics and changes were analyzed in both groups .Results Illness state was controlled and ALT levels were decreased after treatment in all patients and ALT levels had sta -tistically significant differences only at week 8 between the two groups ( P<0 .05 ) .There was no notable distinction between the two groups of HBV-DNA levels in each treatment time point ( P> 0 .05 ) and negative conversion rates of HBeAg and HBsAg were increased in combination group ( P<0 .05) .Furthermore ,adefovir resistance occurred in 2 cases in addition group .Conclusion Viral replication and illness state can be controlled by adefovir dipivoxil combined with lamivudine or interferon in CHB patients with YMDD mutations.However,the combined adefovir dipivoxil and interferon treatment may induce higher negative conversion rates of HBeAg and HBsAg than combined adefovir dipivoxil and lamivudine treatment .%目的 探讨阿德福韦酯(ADV)与干扰素联合治疗拉米夫定耐药慢性乙型肝炎(CHB)的疗效.方法 将53例YMDD变异的CHB患者按其意愿分为2组:加用组(n=38)在继续口服拉米夫定的基础上加用ADV抗病毒治疗,干扰素联合组(n=15)停用拉米夫定,换用ADV联合干扰素抗病毒治疗.2组观察1年,在治疗4、8、12、24、36、48周时检测ALT、乙肝五项、HBVDNA的变化,并分析其临床特点和变化.结果 治疗后2组患者病情均得到控制,ALT水平逐渐降低,仅在8周时2组ALT水平差异有统计学意义(P<0.05);2组HBV-DNA水平在各时间点差异无统计学意义(P＞0.05),但干扰素联合组HBeAg和HBsAg阴转率均要高于加用组(P<0.05).加用组有2例患者出现ADV耐药.结论 加用ADV、ADV与干扰素联合治疗YMDD变异的CHB患者,均能对其病毒和病情起控制作用,但后者显示有更高的HBeAg和HBsAg阴转率.
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