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目的 探讨替比夫定联用阿德福韦酯在HBeAg阳性高病毒载量乙肝患者的治疗效果和安全性.方法 采取简单随机抽样法选取我院肝病专科2014年2月-2015年2月80例HBeAg阳性高病毒载量乙肝患者作为研究对象,按照随机数表法随机分为对照组40例、观察组40例.对照组采用替比夫定治疗,观察组采用替比夫定联用阿德福韦酯治疗.观察两组患者治疗前和治疗3、6、12个月时的HBV DNA载量、HBeAg血清学转换、ALT复常及不良反应情况.结果 观察组6、12个月时的HBV DNA载量对数值比同期对照组降低程度更明显(P＜0.05).观察组治疗6、12个月时HBV DNA阴转率、HBeAg转阴率明显高于对照组.观察组治疗12个月时HBeAg转阴率、血清学转换率及ALT复常率较对照组明显提高.结论 替比夫定联用阿德福韦酯治疗高病毒载量乙肝患者具有较强抗病毒作用,对高病毒载量乙肝患者的临床治疗具有重要意义.“,”Objective To explore the efficacy and safety of the telbivudine and adefovir ester combination therapy on hepatitis B patients with high viral load.Methods From February 2014 to February 2015,80 cases hepatitis B patients with high viral load were selected as the research subjects by using simple random sampling method from the specialized department of liver disease in the hospital.The subjects were divided into a control group (40 cases) and an observation group (40 cases) according to the random indicator method.The control group was treated with telbivudine,and observation group was treated with the telbivudine and adefovir ester combination therapy.The HBV DNA levels,sero-conversion of HBeAg,normalization of ALT and adverse effects in both groups were observed before treatment and 3,6 and 12 months after treatment.Results Log values of HBV DNA after 6 and 12 months of treatments in the observation group were significantly higher than that of control group (P ＜0.05).Negative conversion rates of both HBV DNA and HBeAg in the observation group were significantly higher than those in the control group after 6 and 12 months of treatments.HBeAg sero-conversion rate and normalization rate of ALT in observation group were significantly higher than that of the control group after 12 months of treatments.Conclusions Telbivudine and adefovir ester combination therapy has strong antiviral effect among hepatitis B patients with high viral load,and has great clinical value in the treatment of hepatitis B patients with high viral loads.