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目的探讨基线ALT对阿德福韦酯(ADV)治疗HBe Ag阴性慢性乙型肝炎(CHB)疗效的影响。方法根据基线ALT,将我院2010年6月~2013年1月门诊收治的55例HBe Ag阴性CHB患者分为A、B两组,A组34例,2倍正常上限(2 ULN)≤基线ALT<5 ULN;B组21例,ALT≥5 ULN,均采用ADV治疗,每3个月复查HBV DNA、乙肝标志物及ALT,选取治疗3、6、12、24个月的检验数据进行分析。结果治疗3、6、12、24个月A组HBV DNA下降幅度(lg值)分别为3.3±1.3、3.7±1.1、4.0±1.1、4.1±1.0,B组下降幅度则分别为3.5±1.5、3.9±1.4、4.1±1.4、4.2±1.3,两组各阶段比较差异无统计学意义(P>0.05)。各阶段完全病毒学应答率(<100拷贝/ml):A组为41.2%、55.9%、85.3%、93.6%,B组分别为47.6%、57.1%、76.2%、94.4%,两组比较差异无统计学意义(P>0.05)。生化应答率:A组为55.9%、76.5%、94.1%、100.0%,B组为57.1%、76.2%、95.2%、94.4%,两组比较差异无统计学意义(P>0.05)。治疗过程中,两组均未见HBs Ag转阴或血清学转换,未出现耐药。结论基线ALT≥2 ULN时,ADV疗效不因基线ALT的升高而进一步提升,基线ALT水平对ADV疗效的影响有限。
Objective To investigate the effect of baseline ALT on the efficacy of adefovir dipivoxil in the treatment of HBeAg-negative chronic hepatitis B (CHB). Methods According to the baseline ALT, 55 patients with HBeAg-negative CHB admitted from our hospital from June 2010 to January 2013 were divided into two groups: A group (34 cases), 2-fold upper limit of normal (2 ULN) ≤ baseline ALT <5 ULN; group B, 21 cases, ALT≥5 ULN, were treated with ADV every 3 months review of HBV DNA, hepatitis B markers and ALT, selected treatment 3,6,12,24 months of test data analysis . Results The decrease of HBV DNA in group A was 3.3 ± 1.3, 3.7 ± 1.1, 4.0 ± 1.1 and 4.1 ± 1.0 at 3, 6, 12 and 24 months respectively, and decreased by 3.5 ± 1.5 in group B, 3.9 ± 1.4,4.1 ± 1.4,4.2 ± 1.3. There was no significant difference between the two groups (P> 0.05). The complete virological response rate (<100 copies / ml) in each stage was 41.2%, 55.9%, 85.3% and 93.6% in group A, 47.6%, 57.1%, 76.2% and 94.4% in group B, respectively No statistical significance (P> 0.05). The biochemical response rate was 55.9%, 76.5%, 94.1% and 100.0% respectively in group A and 57.1%, 76.2%, 95.2% and 94.4% in group B, respectively. There was no significant difference between the two groups (P> 0.05). During the course of treatment, no HBsAg negative or seroconversion was observed in both groups, and no resistance was observed. Conclusions When baseline ALT ≥ 2 ULN, the efficacy of ADV is not further enhanced by baseline ALT elevation. The baseline ALT level has a limited effect on the efficacy of ADV.