Effective Treatment for Patients with Viral Relapse after Adefovir Withdrawl by the Combination of Lamivudine plus Adefovir_West China Medical Journal

Authors：

LIU Jie , QI Jun

Department of Infectious Diseases, First People’s Hospital of Liangshan, Xichang, Sichuan 615000, P. R. China;

Corresponding author：

Keywords：

慢性乙型肝炎; 病毒学反弹; 阿德福韦酯; 拉米夫定; 联合治疗

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目的　比较拉米夫定+阿德福韦酯联合治疗与阿德福韦酯单药治疗对阿德福韦酯停药后出现病毒学反弹而无基因型耐药变异患者的疗效及安全性。方法　回顾研究2007年1月－2012年1月在传染科门诊就诊的67例阿德福韦酯治疗获得病毒学应答但停药后出现病毒学反弹的e抗原阳性慢性乙型肝炎患者，分别给予拉米夫定+阿德福韦酯联合治疗（联合组，n=35）和阿德福韦酯单药治疗（单药组，n=32）。结果　治疗1年后，联合组（32例，85.7%）较单药组（21例，65.6%）有更多的患者重新获得了丙氨酸转氨酶复常（P=0.009），联合组34例（97.1%）乙型肝炎病毒DNA阴转，单药组22例（68.8%）阴转，两组差异有统计学意义（P=0.002）；在血清学转换方面，联合组和单药组分别有4例（11.4%）和1例（3.1%）患者获得了e抗原的血清学转换。在治疗中所有患者均未发生任何严重不良反应。结论　阿德福韦酯停药后出现病毒学反弹，选择拉米夫定与阿德福韦酯联合治疗可使患者重新获得较好的生化学和病毒学应答。

Citation： LIU Jie,QI Jun. Effective Treatment for Patients with Viral Relapse after Adefovir Withdrawl by the Combination of Lamivudine plus Adefovir. West China Medical Journal, 2012, 27(8): 1143-1145. doi: Copy

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1. 　Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures[J]. J Viral Hepat, 2004, 11(2): 97-107.
2. 　Song BC, Suh DJ, Lee HC, et al. Hepatitis B e antigen seroconversion after lamivudine therapy is not durable in patients with chronic hepatitis B in Korea[J]. Hepatology, 2000, 32(4 Pt 1): 803-806.
3. 　Dienstag JL, Cianciara J, Karayalcin S, et al. Durability of serologic response after lamivudine treatment of chronic hepatitis B[J]. Hepatology, 2003, 37(4): 748-755.
4. 　Ito K, Tanaka Y, Orito E, et al. Predicting relapse after cessation of Lamivudine monotherapy for chronic hepatitis B virus infection[J]. Clin Infect Dis, 2004, 38(4): 490-495.
5. 　中华医学会肝病学分会，中华医学会感染病学分会. 慢性乙型肝炎防治指南[J]. 中华肝脏病杂志, 2006, 9(1): 8-18.
6. 　European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B[J]. J Hepatol, 2009, 50(2): 227-242.
7. 　Delaney WE 4th. Progress in the treatment of chronic hepatitis B: long-term experience with adefovir dipivoxil[J]. J Antimicrob Chemother, 2007, 59(5): 827-832.
8. 　Lim SG, Cheng Y, Guindon S, et al. Viral quasi-species evolution during hepatitis Be antigen seroconversion[J]. Gastroenterology, 2007, 133(3): 951-958.
9. 　Lok AS, Zoulim F, Locarnini S, et al. Antiviral drug-resistant HBV: standardization of nomenclature and assays and recommendations for management[J]. Hepatology, 2007, 46(1): 254-265.
10. 　Sanchez MJ, Buti M, Homs M, et al. Successful use of entecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab[J]. J Hepatol, 2009, 51(6): 1091-1096.
11. 　白浪，杨文斌，刘丽，等. 阿德福韦酯联合拉米夫定治疗阿德福韦酯应答不佳的慢性乙型肝炎的临床观察[J]. 华西医学, 2011, 26(9): 1281-1283.
12. 　刘锋，朱利红，孔亚兰，等.替比夫定联合阿德福韦酯治疗阿德福韦酯应答不佳的乙型肝炎病毒e抗原阳性慢性乙型肝炎患者[J]. 华西医学, 2012, 27(1): 14-17.

West China Medical Journal

Effective Treatment for Patients with Viral Relapse after Adefovir Withdrawl by the Combination of Lamivudine plus Adefovir

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