替比夫定治疗对阿德福韦酯应答不佳慢性乙型肝炎24个月疗效分析

目的：评估应用替比夫定对阿德福韦酯治疗应答不佳慢性乙型肝炎24个月疗效。方法66例对阿德福韦酯单药治疗应答不佳的HBeAg阳性慢性乙型肝炎患者随机分成2组，A组采用替比夫定（600 mg，1次·d-1，口服），单药治疗，B 组在原阿德福韦酯治疗（10 mg，1次·d-1，口服）的基础上加用替比夫定治疗。治疗期间监测肝功能、HBV标志物、HBV DNA变化情况及耐药情况。观察24个月。结果治疗24个月，A组HBV DNA转阴率为78.8%，HBeAg血清学转换率为21.2%，而B组患者HBV DNA转阴率为97.0%，HBeAg血清学转换率为45.5%。两组比较差异有统计学意义。A组共有4例（12.1%）患者出现耐药，B组为0。无患者因出现严重不良反应而终止抗病毒治疗。结论阿德福韦酯抗病毒治疗应答不佳的HBeAg阳性慢性乙型肝炎患者联合替比夫定进一步治疗具有较好的疗效，而且安全性高，耐药率低。

Clinical efficacy of telbivudine in the treatment of chronic hepatitis B with poor response to adefovir dipivoxil for 24 months

Objective To evaluate the clinical effecacy of telbivudine in the treatment of chronic hepatitis B patients with poor response to adefovir dipivoxil for 24 months. Methods 66 cases of HBeAg-positive chronic hepatitis B patients with poor response to adefovir dipivoxil were randomly divided into two groups. Group A was given telbivudine （600mg·d-1）. Group B was given telbivudine and adefovir dipivoxil （10mg·d-1）. The differences of ALT normaIization rate, HBeAg/HBeAb seroconversion rate and HBV-DNA negative rate between the two groups were compared after 24-month therapy. Results After 24-month therapy, HBV-DNA negative rate and HBeAg/HBeAb seroconversion rate for group A were 78.8%and 21.2%, while those for group B were 97.0%and 45.5%. The indicators of group B were significantIy better than group A. Four cases （12.1%） of group A but none of group B appeared viral resistance. No patient terminated the treatment due to severe adverse event. Conclusion Combination of telbivudine and adefovir dipivoxil has good effect for patients of HBeAg-positive chronic hepatitis B with poor response to adefovir dipivoxil. The treatment is safe and of low viral resistance rate.