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目的探讨恩替卡韦联合阿德福韦酯在耐拉米夫定慢性乙型肝炎(chronic hepatitis B,CHB)患者中的临床应用价值。方法选取2012年10月—2014年3月收治的108例耐拉米夫定的CHB患者为研究对象,根据其就诊时间分成研究组和对照组各54例。研究组予以口服恩替卡韦片方案,对照组则予以恩替卡韦片+阿德福韦酯胶囊联合用药方案。行为期12个月的随访,对比两组患者治疗3个月(T1)、治疗6个月(T2)及治疗12个月(T3)的HBs Ag阴转率、HBV-DNA阴转率及ALT复常率变化差异,记录其治疗前后肝功能指标变化情况。计量资料比较采用t检验,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果研究组患者HBs Ag阴转率及HBV-DNA阴转率均显著高于对照组,差异均有统计学意义(均P<0.05)。治疗12个月后,两组患者ALT、TBIL、ALB水平[(35.4±10.8)U/L、(18.6±4.8)μmol/L、(35.1±2.5)g/L与(67.7±12.4)U/L、(50.6±6.1)μmol/L、(40.8±2.5)g/L]均较治疗前[(815.6±226.8)U/L、(105.5±23.5)μmol/L、(45.5±2.8)g/L与(820.6±228.1)U/L、(105.8±23.1)μmol/L、(45.6±2.7)g/L]显著降低,其中研究组患者降幅大于对照组,差异均有统计学意义(均P<0.05)。结论对耐拉米夫定的CHB患者予以恩替卡韦联合阿德福韦酯方案,疗效确切,可有效提高Hbs Ag及HBV-DNA的阴转率,改善肝功能,值得临床推广。
Objective To investigate the clinical value of entecavir combined with adefovir dipivoxil in patients with chronic hepatitis B (CHB) resistant to lamivudine. Methods A total of 108 patients with CHB treated with lamivudine from October 2012 to March 2014 were selected and divided into study group (54 cases) and control group (54 cases). The study group was given oral entecavir tablets program, the control group was given entecavir tablets + adefovir dipivoxil capsules combination regimen. During the 12-month follow-up, the HBs Ag negative conversion rate, HBV-DNA negative conversion rate and ALT were compared between the two groups for 3 months (T1), 6 months (T2) and 12 months Changes in the rate of change of complex, record changes in liver function indicators before and after treatment. Measurement data were compared using t test, count data were compared using χ2 test, P <0.05 for the difference was statistically significant. Results The negative rate of HBsAg and the negative rate of HBV DNA in study group were significantly higher than those in control group (all P <0.05). The levels of ALT, TBIL and ALB in the two groups after treatment for 12 months [(35.4 ± 10.8) U / L, (18.6 ± 4.8) μmol / L, (35.1 ± 2.5) g / L and (67.7 ± 12.4) U / L, (50.6 ± 6.1) μmol / L and (40.8 ± 2.5) g / L] were significantly higher than those before treatment [(815.6 ± 226.8) L and (820.6 ± 228.1) U / L, (105.8 ± 23.1) μmol / L and (45.6 ± 2.7) g / L] in the study group were significantly lower than those in the control group, with significant differences <0.05). Conclusions Entecavir combined with adefovir dipivoxil regimen in patients with CHB resistant to lamivudine is effective and can effectively improve the negative conversion rate of HbsAg and HBV-DNA and improve liver function, which deserves clinical promotion.