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目的观察阿德福韦酯联合拉米夫定治疗耐药HBeAg阴性慢性乙型肝炎YMDD变异的临床疗效。方法拉米夫定耐药HBeAg阴性慢乙型肝炎患者60例分A组30例、B组30例,动态观察患者血清HBVDNA、HBeAg、HBeAb和肝功能变化。结果 A组HBVDNA阴转率在12、24、48、72周时分别为30.0%、43.3%、50.0%、76.7%,B组分别为26.7%、33.3%、40.0%、46.7%,但两组之间比较在72周时差异有统计学意义(χ2=2.855,P<0.05);A、B两组ALT复常率比较在12周时A组明显高于B组,差异有统计学意义(χ2=2.703,P<0.05)。结论阿德福韦酯单独或联合拉米夫定,对拉米夫定耐药的HBeAg阴性慢性乙型肝炎均有治疗作用;联合用药效果更好。
Objective To observe the clinical efficacy of adefovir dipivoxil combined with lamivudine in treatment of YMDD mutation in drug-resistant HBeAg-negative chronic hepatitis B patients. Methods Sixty patients with lamivudine-resistant HBeAg-negative chronic hepatitis B were divided into group A (n = 30) and group B (n = 30). Serum HBVDNA, HBeAg, HBeAb and hepatic function were observed dynamically. Results The negative conversion rates of HBVDNA in group A were 30.0%, 43.3%, 50.0% and 76.7% at 12, 24, 48 and 72 weeks, respectively, while those in group B were 26.7%, 33.3%, 40.0% and 46.7% (Χ2 = 2.855, P <0.05). The ALT normalization rate in A and B groups was significantly higher than that in B group at 12 weeks (P <0.05), the difference was statistically significant ( χ2 = 2.703, P <0.05). Conclusion Adefovir dipivoxil, alone or in combination with lamivudine, has a therapeutic effect on lamivudine-resistant HBeAg-negative chronic hepatitis B; combination therapy is better.