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目的:评价拉米夫定与阿德福韦酯联用对慢性乙型肝炎(CHB)患者的临床疗效及其对肝功能和血清HBV-DNA水平的影响。方法:选取2016年2月—2017年3月间收治的CHB患者120例临床资料,将其随机分成对照组和观察组,每组60例;对照组患者给予拉米夫定治疗,观察组患者在对照组基础上加用阿德福韦酯治疗;比较两组患者治疗前和治疗6月、12月时HBV-DNA、HbeAg转阴率、肝功能复常率和YMDD基因的突变情况。结果:治疗前和治疗6月、12月时观察组患者HBV-DNA转阴率高于对照组(P<0.05),但是两组患者的HBeAg血清转换率及其转阴率经组间比较其差异无统计学意义(P>0.05);观察组患者治疗6月、12月时ALT复常率高于对照组(P<0.05),YMDD相关基因突变的发生率低于对照组(P<0.05)。结论:采用拉米夫定与阿德福韦酯联用治疗方案,其疗效优于单用拉米夫定,可有效改善了HBV耐药。
Objective: To evaluate the clinical efficacy of lamivudine combined with adefovir dipivoxil in patients with chronic hepatitis B (CHB) and its effect on liver function and serum HBV-DNA level. Methods: The clinical data of 120 CHB patients admitted from February 2016 to March 2017 were selected and randomly divided into control group and observation group, 60 cases in each group. Patients in the control group were treated with lamivudine. The patients in the observation group Adefovir dipivoxil treatment was added to the control group. HBV-DNA, HbeAg negative rate, normal liver function recovery rate and YMDD gene mutation were compared between two groups before treatment and at 6 and 12 months. Results: The HBV-DNA negative rate in the observation group was higher than that in the control group (P <0.05) before treatment and in the treatment group at 6 and 12 months. However, the HBeAg seroconversion rate and the negative conversion rate of the two groups were compared There was no significant difference between the two groups (P> 0.05). The recovery rate of ALT in the observation group was significantly higher than that in the control group at 6 and 12 months (P <0.05), and the incidence of YMDD-related gene mutation was lower than that in the control group ). Conclusion: The combination therapy with lamivudine and adefovir dipivoxil has better curative effect than lamivudine alone, which can effectively improve the HBV resistance.