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目的探究阿德福韦酯(ADV)联合拉米夫定(ALM)治疗停用ALM后出现病毒学反弹的慢性乙肝(CHB)的效果,并对其安全性作出评价。方法抽取2010年4月至2013年4月六安市立医院收治的经ALM治疗获得病毒学应答但停药后出现病毒学反弹的e抗原阳性CHB患者100例纳入本次研究,按照治疗方式的不同分为对照组与实验组各50例,对照组给予ALM治疗,实验组在此基础上给予ADV治疗,观察两组患者治疗1年后的临床效果。结果实验组患者治疗后的血清为内氨酸氨基转移酶、总胆红素、凝血酶原活动度改善明显优于对照组(P<0.05),实验组HBe Ag转阴情况与HBV-DNA转阴情况明显优于对照组(P<0.05),两组比较差异有统计学意义。结论对于使用ALM停药后出现病毒学反弹的患者,再次进行治疗时使用ADV联合ALM治疗,具有良好的临床效果,可使患者重新获得较好的生化学和病毒学应答。
Objective To investigate the effect of adefovir dipivoxil (ADV) combined with lamivudine (ALM) on the development of virological rebound chronic hepatitis B (CHB) after deactivation of ALM and to evaluate its safety. Methods One hundred patients with positive e antigen-CHB who received virological response after ALM treatment and who had virological rebound after withdrawal from April 2010 to April 2013 in Lu’an Municipal Hospital were enrolled in this study. According to the different treatment methods Divided into the control group and the experimental group of 50 cases, the control group given ALM treatment, the experimental group on the basis of ADV treatment, the two groups were observed after 1 year of clinical effect. Results After treatment, the serum of patients in experimental group was endotain aminotransferase, the total bilirubin and prothrombin activities were significantly improved than that of the control group (P <0.05). In the experimental group, Yin situation was significantly better than the control group (P <0.05), the difference between the two groups was statistically significant. Conclusions For those patients who developed virological rebound after discontinuation of ALM, the combination of ADV and ALM for re-treatment resulted in a good clinical outcome that would allow patients to regain better biochemical and virologic response.