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目的比较阿德福韦酯(ADV)单药及其联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎(chronic hepatitis B,CHB)的临床疗效。方法对24例ADV单药及28例ADV联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎患者的疗效进行回顾性分析,比较两组患者HBV DNA、ALT水平及HBV DNA检测不到率、ALT复常率的差异。结果两组患者的性别、年龄、治疗前的HBV DNA及ALT水平差异均无统计学意义。两组的HBV DNA、ALT水平在治疗48周、72周时分别与同组治疗前比较均有明显降低(P<0.05)。治疗48周时,联合组的HBV DNA检测不到率虽高于单药组,但差异无统计学意义(50% vs 25%,P>0.05);ALT复常率两组间无明显差别(67.9% vs 75%,P>0.05)。治疗72周时,联合组的HBV DNA检测不到率为68%,要显著高于单药组的33.3%(P<0.05);联合组的ALT复常率为93%,显著高于单药组的70.8%(P<0.05)。结论 ADV单药或联合拉米夫定均是治疗拉米夫定耐药HBeAg阳性CHB的有效方法,联合治疗的疗效要优于单药治疗。
Objective To compare the clinical efficacy of adefovir dipivoxil (ADV) monotherapy combined with lamivudine in the treatment of lamivudine-resistant HBeAg-positive chronic hepatitis B (CHB). Methods The curative effect of 24 patients with ADV and 28 patients with ADV combined with lamivudine for lamivudine-resistant HBeAg-positive chronic hepatitis B were retrospectively analyzed. The levels of HBV DNA, ALT and HBV DNA Undetectable rate, ALT normalization rate difference. Results There was no significant difference in gender, age, pre-treatment HBV DNA and ALT between the two groups. The levels of HBV DNA and ALT in both groups were significantly lower at the 48th week and the 72th week than those in the same group before treatment (P <0.05). At 48 weeks, the undetectable HBV DNA in the combination group was significantly higher than that in the single drug group (50% vs 25%, P> 0.05). There was no significant difference between the two groups 67.9% vs 75%, P> 0.05). At 72 weeks, the undetectable rate of HBV DNA in the combined group was 68%, significantly higher than that in the single drug group (33.3%, P <0.05). The ALT normalization rate in the combined group was 93%, significantly higher than that in the single drug group 70.8% of the group (P <0.05). Conclusion Both ADV and lamivudine are effective methods for the treatment of lamivudine-resistant HBeAg-positive CHB. The combination therapy is superior to monotherapy.