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目的:比较阿德福韦酯(ADV)疗效欠佳患者采取继续ADV治疗与联合拉米夫定(LMV)或替比夫定(LdT)优化治疗的疗效差异,旨在寻求一种优化方案用于治疗阿德福韦疗效欠佳的慢性乙型肝炎患者。方法:将ADV治疗48周后效果欠佳的慢性乙型肝炎患者分为3组:(1)对照组(A组):继续单用ADV10 mg·d-1治疗,(2)ADV联合LMV(B组):ADV10 mg·d-1,LMV100 mg·d-1优化联合治疗,(3)ADV联合LdT((C组):ADV10 mg·d-1,LdT600 mg·d-1优化联合治疗,比较3组研究对象继续治疗96周的疗效差异及不良反应。结果:521例门诊服用ADV10 mg·d-1的患者48周时共出现127例ADV疗效欠佳者,其中对照组34例,观察组B、C分别55例、38例。治疗48周和96周后,观察组(B组和C组)的ALT复常率、HBV DNA降幅平均值、HBV DNA阴转率、病毒学突破率与对照组差异显著;HBeAg/HBeAb血清学转换率与对照组差异不明显。3组患者服药期间耐受性、依从性良好,部分患者出现血清肌酐水平及磷酸肌酸激酶水平轻度升高,但无一例因严重不良反应导致停药。结论:对于ADV单药治疗过程中发生ADV疗效欠佳的患者,ADV联合LMV、ADV联合LdT是两种安全有效的优化联合治疗方案。
OBJECTIVE: To compare the efficacy of continuing adefovir dipivoxil with optimized lamivudine (LMV) or telbivudine (LdT) in patients with poor response to adefovir dipivoxil (ADV) in order to find an optimal regimen In the treatment of adefovir ineffective chronic hepatitis B patients. Methods: The patients with chronic hepatitis B after 48 weeks of ADV treatment were divided into three groups: (1) control group (group A): treated with ADV10 mg · d-1 alone, (2) ADV combined with LMV (Group B): ADV10 mg · d-1 and LMV100 mg · d-1. (3) ADV combined with LdT (group C): ADV10 mg · d-1 and LdT600 mg · d- The difference in efficacy and adverse reactions of the three groups were compared for 96 weeks.Results: In the 521 outpatients who took ADV10 mg · d-1, there were 127 cases of ADV ineffective at 48 weeks, of which 34 cases in the control group were observed Group B, C, respectively, 55 cases, 38 cases.After 48 weeks and 96 weeks of treatment, observation group (group B and group C) ALT normalization rate, the average decrease of HBV DNA, HBV DNA negative conversion rate, virological breakthrough rate There was significant difference between the HBeAg / HBeAb seroconversion rate and the control group.The tolerance and compliance of HBeAg / HBeAb seroconversion in the three groups were good, the serum creatinine level and creatine phosphokinase level increased slightly in some patients, However, none of them discontinued due to serious adverse reactions.CONCLUSIONS: ADV combined with LMV and ADV combined with LdT are two safe and effective optimized combinations for patients with poor outcome in ADV monotherapy. Treatment programs.