摘要
目的探讨并分析拉米夫定联合阿德福韦酯对阿德福韦酯初始治疗不佳的慢性乙型肝炎患者的临床疗效。方法选择2011年1月~2013年6月收治的81例慢性乙型肝炎患者,均为经阿德福韦酯初始治疗后又出现了慢性乙型肝炎血清标志物,所有患者均给予常规护肝治疗并随机分为3组:Ⅰ组:27例,患者使用阿德福韦酯联合拉米夫定用药48周;Ⅱ组:27例,患者使用阿德福韦酯联合拉米夫定12周后继续单独使用阿德福韦酯用药36周;Ⅲ组:27例,常规护肝治疗基础上,患者使用拉米夫定单独用药48周。分别于第12、24、48周的每周末检测并观察各组患者的HBV-DNA应答率、HBeAg转阴率、ALT复常率等相关指标及患者病情好转情况。结果治疗时间在12周时各组HBV-DNA应答率、HBeAg转阴率、ALT复常率的比较均无统计学差异。但随着治疗时间的持续增加,患者经过48周治疗后,Ⅰ组的HBV-DNA应答率、HBeAg转阴率、ALT复常率均显著高于Ⅲ组(P<0.05),而Ⅱ组与Ⅲ组相比这些指标差异无统计学意义。结论拉米夫定联合阿德福韦酯持续使用48周后,慢性乙型肝炎患者的抗病毒治疗要比单纯使用拉米夫定治疗效果更好,而2者联合使用12周的治疗效果并不是十分理想。因此,对治疗初次口服阿德福韦酯治疗失败的患者应持续使用拉米夫定与阿德福韦酯联合治疗48周以上具有较好的临床疗效。
Objective To investigate and analyze the clinical curative effect of lamivudine combined with adefovir dipivoxil for failed adefovir dipivoxil therapy of chronic hepatitis B. Methods 81 cases of patients with chronic hepatitis B received from January 2011 to June 2013 were given conventional liver protection treatment and randomly divided into three groups,27 cases in each group. Patients in Group I were treated with adefovir dipivoxil and lamivudine for 48 weeks; patients in Group II were given adefovir dipivoxil and lamivudine for 12 weeks and then treated with adefovir dipivoxil alone for 36 weeks; on the basis of convention liver protection therapy,patients in Group III were given lamivudine monotherapy for 48 weeks. At the weekends of 12,24 and 48 weeks,their index of HBV-DNA response rate,HBeAg negative conversion rate,the recovery rate of ALT in the three groups were detected and observed. Results At the time of 12 weeks,HBV-DNA response rate,HBeAg negative conversion rate,the recovery rate of ALT,there were no statistical differences in three groups. But after 48 weeks of treatment,HBV-DNA response rate,HBeAg negative conversion rate and the recovery rate of ALT in Group I were significantly higher than those in Group III(P < 0. 05),but there were no statistically difference between Group II and Group III. Conclusion Lamivudine combined with adefovir dipivoxil for failed adefovir therapy of chronic hepatitis B for 48 weeks has a better efficacy of antiviral treatment for HVB patients than the simple use of lamivudine,and the combination of lamivudine and adefovir dipivoxil for 12 weeks does not have an ideal effect. Therefore,patients whose first treatment failed by using oral adefovir dipivoxil should continue to use the combination of lamivudine and adefovir dipivoxil treatment for more than 48 weeks to have a better clinical effect.
出处
《中国生化药物杂志》
CAS
北大核心
2014年第5期157-159,共3页
Chinese Journal of Biochemical Pharmaceutics
关键词
拉米夫定
阿德福韦酯
联合治疗
乙型肝炎
lamivudine
adefovir dipivoxil
combination therapy
hepatitis B
