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目的比较拉米夫定和阿德福韦酯初始联合与恩替卡韦单药治疗慢性乙型肝炎的疗效,为慢性乙型肝炎患者提供合理治疗方案.方法选择我院2010年7月~2011年9月符合抗病毒治疗的未曾使用过核苷(酸)类似物的初治慢性乙型肝炎患者80例,分为联合组40例,单药组40例,联合组用拉米夫定100mg,阿德福韦酯10mg,1次/日;单药组用恩替卡韦0.5mg,1次/日,均口服.分别在基线、12、24、48、72周时留取血清,检测相关指标并进行比较.nrn结果联合组36例,单药组34例完成了72周随访,两组患者治疗前性别、年龄、血清ALT、胆红素、HBV DNA、HBeAg阳性率、血肌酐比较差异均无统计学意义(P>0.05);在治疗不同时间联合组和单药组生化应答比例及与基线比较两组HBV DNA下降绝对值差异均无统计学意义(P>0.05);联合组和单药组在治疗12、24、48周时HBV DNA0.05);但是在治疗72周时HBV DNA<500拷贝/ml的患者比率及HBeAg血清转换率联合组分别为88.9%、30.4%,单药组分别76.5%、12.5%,两组比较差异有统计学意义(P均0.05);The ALT normaLization and the mean values of decreases for HBV viral loads were smilar in both cohorts in the treatment of different time;The rates of HBV DNA0.05);At the time point of 72 weeks,the rates of HBV DNA<500 copies/ml(88.9%vs76.5%)and the HBeAg seroconve-rsion(30.4%vs12.5%)were markedly higher in combination therapy cohort than those of monotherapy cohort statisticaly (P<0.05 for al);No mutation of the virus and drug resistance occurred in both cohorts during the treatment,and not found the drug related kidney damage and other serious adverse reaction,the tolerance are good.ConclusionsPresent study suggests that Lamivudine plus Adefovir denovo Combination therapy was more efficacious than Entecavir monotherapy for chronic hepatitis B patients,and the safety between the two cohorts had no significant .