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目的:比较阿德福韦酯(ADV)疗效欠佳患者继续采取ADV治疗与换用恩替卡韦(ETV)优化治疗的疗效差异。方法:将2007年1月至2012年12月在中山大学附属第三医院收治的52例服用ADV治疗的慢性乙型肝炎患者纳入研究.将ADV治疗48周疗效欠佳的慢性乙型肝炎患者分为对照组(继续ADV治疗)和优化组(联合ETV治疗),治疗48周后比较两组疗效。结果:521例患者中ADV疗效欠佳者170例,其中34例继续ADV治疗(对照组)、43例联合ETV优化治疗(优化组)。继续治疗48周时,两组患者生化学指标较治疗前均明显改善,ALT复常率均较高,但两组比较,差异无统计学意义(P>0.05)。优化组HBV DNA降幅、HBV DNA阴转率方面均明显高于对照组,差异有统计学意义(P<0.05),但HBeAg阴转率、HBeAg/HBeAb血清学转换率方面,两组比较,差异无统计学意义(P>0.05)。7例(对照组3例、优化组4例)出现磷酸肌酸激酶升高。结论:对ADA疗效欠佳的慢性乙型肝炎患者换用ETV是一种行之有效的优化治疗方案。
OBJECTIVE: To compare the differences in the efficacy of adefovir dipivoxil (ADV) in continuing treatment with ADV and optimal treatment with entecavir (ETV). Methods: A total of 52 chronic hepatitis B patients treated with ADV were enrolled in the Third Affiliated Hospital of Sun Yat-sen University from January 2007 to December 2012. Adverse treatment of chronic hepatitis B patients treated with ADV for 48 weeks For the control group (continue ADV treatment) and the optimization group (combined ETV treatment), after 48 weeks of treatment, the two groups were compared. Results: Among 521 patients, 170 cases were treated with ADV ineffectively. Of them, 34 cases continued ADV treatment (control group) and 43 cases combined with ETV optimization treatment group (optimized group). At the 48th week of continuous treatment, the biochemical parameters of both groups were significantly improved compared with those before treatment, and the rate of ALT recovery was high. However, there was no significant difference between the two groups (P> 0.05). The decrease of HBV DNA and the rate of HBV DNA negative conversion in the optimized group were significantly higher than those in the control group (P <0.05). However, the differences in HBeAg negative rate and HBeAg / HBeAb seroconversion rate between the two groups were statistically significant No statistical significance (P> 0.05). Elevated creatine phosphokinase appeared in 7 patients (3 in control group and 4 in optimized group). CONCLUSIONS: Switching to ETV in patients with chronic hepatitis B who are poorly-treated with ADA is an effective and optimal treatment.