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目的探讨联合阿德福韦酯和恩替卡韦比较治疗拉米夫定耐药的HBs Ag阳性肾移植患者的疗效。方法纳入2007年1月至2012年3月在四川大学华西医院和三台县人民医院门诊或住院经拉米夫定治疗后出现耐药的HBs Ag阳性肾移植患者,比较不同随访时间下两组患者肝功能、肾功能及不良反应的差异。统计分析采用SPSS 16.0软件。结果共纳入15例患者,平均年龄为36.7±6.6岁,男性患者为主。经治疗4周、12周、24周、48周、96周,A、B两组肝功复常率、HBV-DNA载量阴转率和肌酐水平均无统计学差异(P>0.05)。结论 HBs Ag阳性肾移植患者出现拉米夫定耐药后采用与阿德福韦酯联合治疗或换用恩替卡韦均可有效抑制乙肝病毒复制,但有部分患者未能达到HBV-DNA载量降至最低检测值下限的疗效;使用阿德福韦酯的部分患者可能会出现肌酐升高;初始即采用高效、对肾功能影响小、低耐药发生率的抗乙肝病毒治疗药物可能更适合于HBs Ag阳性肾移植患者。
Objective To investigate the efficacy of combination of adefovir dipivoxil and entecavir in the treatment of lamivudine-resistant HBsAg-positive renal transplant recipients. Methods A retrospective study was conducted between January 2007 and March 2012 in HBsAg-positive renal transplant recipients who were treated with lamivudine at West China Hospital and Santai People’s Hospital of Sichuan University during the outpatient period or hospitalization. Two groups were compared at different follow-up periods Patients with liver function, renal function and adverse reactions. Statistical analysis using SPSS 16.0 software. Results A total of 15 patients were enrolled, with an average age of 36.7 ± 6.6 years and predominantly male patients. After 4 weeks, 12 weeks, 24 weeks, 48 weeks and 96 weeks of treatment, there was no significant difference (P> 0.05) in the rate of normalization of liver function, the negative conversion rate of HBV-DNA load and the creatinine level in group A and B (P> 0.05). Conclusion HBsAg-positive renal transplantation patients with lamivudine resistance after treatment with adefovir dipivoxil or switch to entecavir can effectively inhibit hepatitis B virus replication, but some patients failed to achieve HBV-DNA load down to The lowest detection limit of the efficacy of some users of adefovir dipivoxil may have elevated creatinine; initial high-efficiency, small effect on renal function, the incidence of low resistance to anti-hepatitis B virus drugs may be more suitable for HBs Ag positive kidney transplant patients.