龙云升　罗林

[摘要]目的 探讨拉米夫定序贯/联合阿德福韦酯治疗慢性乙型肝炎的临床疗效。 方法 选取我院2011年1月～2013年1月收治的慢性乙型肝炎患者79例，随机分为序贯组（40例）和联合组（39例），两组均常规予以保肝治疗，序贯组予以拉米夫定序贯阿德福韦酯进行治疗，联合组予以拉米夫定联合阿德福韦酯进行治疗，比较分析两组的临床疗效。 结果 联合组用药12个月和24个月时的肝功能指标改善程度显著优于序贯组（P<0.05）；两组HBeAg、HBV DNA转阴率无明显差异（P>0.05），HBV DNA定量显著低于序贯组（P<0.05）；联合组用药12个月、24个月的拉米夫定耐药突变率分别为10.3%、2.6%，显著低于序贯组的35.0%、20.0%（P<0.05）；两组阿德福韦酯的耐药突变率无明显差异（P>0.05）。 结论 拉米夫定联合阿德福韦酯片治疗慢性乙型肝炎具有显著疗效，耐药率低，值得进一步研究应用。

[关键词]拉米夫定；性慢性乙型肝炎；治疗效果

[中图分类号] R512.62 [文献标识码] B [文章编号] 2095-0616（2014）13-61-04

[Abstract]Objective To investigate the clinical efficacy of lamivudine and adefovir sequential or combined in treatment of chronic hepatitis B. Methods 79 patients with chronic hepatitis B in our hospital between January 2011 and January 2013 were randomly divided into sequential group （40 cases） and the combination group （39 cases）， both groups were received routine liver treatment.the sequential group received lamivudine adefovir sequential treatment， the combination group received lamivudine combined adefovir treatment. The clinical efficacy of the two groups was comparative analysised. Results The degree of improvement in liver function in combination group for 12 months and 24 months were significantly better than the sequential group （P<0.05）； HBeAg abd HBV DNA negative rate in two groups was no significant difference （P>0.05）， HBV DNA quantification was significantly lower than the sequential group （P<0.05）； combined group treatment for 12 months， the rate of lamivudine resistance mutations 24 months was 10.3%， 2.6%， respectively， significantly lower than the 35.0% sequential group， 20.0% （P<0.05）； resistant mutation rate of adefovir dipivoxil groups had no significant difference （P>0.05）. Conclusion Lamivudine combined with adefovir dipivoxil tablets in the treatment of chronic hepatitis B have a significant effect and low resistance， it's worthy of further research

[Key words] Lamivudine； Chronic hepatitis B； Treatment effect

慢性乙型肝炎作为临床上一种常见的传染性疾病，具有高发病率、传染性强、死亡率高等特点[1]，若不及时治疗可能发展成肝癌或肝硬化，严重威胁人类生命健康。拉米夫定能有效的抑制病毒DNA链的合成和延长，是当下治疗乙型肝炎病毒感染的重要药物[2]。但拉米夫定在用药9～11个月左右即可出现耐药，而耐药将引起病毒水平升高以及病情进展甚至恶化。既往研究资料显示，对拉米夫定耐药患者可以应用阿德福韦酯单药或者联合应用进行治疗。本研究对比分析了拉米夫定序贯阿德福韦酯和拉米夫定联合阿德福韦酯治疗慢性乙型肝炎的临床疗效，旨在为临床正确选择治疗方案提供参考，现报道如下。

1 资料与方法

1.1 一般资料