拉米夫定耐药的慢性乙型肝炎至5年的阿德福韦酯联合治疗后

肝胆速递

http://www.ncbi.nlm.nih.gov/pubmed/22951420##
Antivir Ther. 2012 Sep 6. doi: 10.3851/IMP2335. [Epub ahead of print]
Outcome of lamivudine-resistant chronic hepatitis B after up to 5 years of combination therapy with adefovir.
Seto WK, Liu K, Fung J, Wong DK, Yuen JC, Hung IF, Lai CL, Yuen MF.
Source

Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong.
Abstract
OBJECTIVE:

There is a paucity of data on the long-term efficacy of combination lamivudine and adefovir in patients with lamivudine-resistant chronic hepatitis B (CHB).
METHODS:

We determined the cumulative virologic, serologic and biochemical outcomes of 165 lamivudine-resistant CHB patients on lamivudine and adefovir for up to 5 years. Resistance profiles using a line probe assay were determined among patients with detectable viremia. The significance of different baseline and on-treatment virologic parameters was analyzed.
RESULTS:

The median age and duration of follow-up were 45.1 years and 37.1 months respectively. The cumulative rates of HBV DNA undetectability (< 20 IU/mL), ALT normalization and hepatitis B e antigen (HBeAg) seroconversion up to 5 years were 74.0%, 95.1% and 44.4% respectively. One patient achieved hepatitis B surface antigen (HBsAg) seroclearance. The 5-year cumulative resistance rate to adefovir was 10.2%. Among different baseline and on-treatment virologic parameters, week 24 HBV DNA < 200 IU/mL was associated with an increased chance of long-term virologic suppression (p < 0.001, odds ratio 13.89, 95% confidence interval 3.90 - 49.46). Primary non-response and high baseline viral titers were not useful in predicting long-term virologic outcomes. The 5-year cumulative rate of serum creatinine elevation > 0.5 mg/dL was 4.1%.
CONCLUSION:

Combination lamivudine and adefovir up to 5 years achieved modest rates of virologic suppression but resistance developed in only 10.2% of patients. Week 24 HBV DNA < 200 IU/mL was predictive of favorable long-term virologic outcomes, and could be used to assist treatment decisions on continuing lamivudine and adefovir or switching to more potent therapy.

肝胆速递

小红疗法2012年9月6日。 DOI：10.3851/IMP2335。 [EPUB的提前打印]

拉米夫定耐药的慢性乙型肝炎至5年的阿德福韦酯联合治疗后的结果。

洪濑户WK，J，K，冯刘皇DK，元朗JC，IF，赖CL，元MF。
源

医学系，香港大学，玛丽医院，香港。
抽象
目的：

有很少的数据组合拉米夫定和阿德福韦与拉米夫定耐药的慢性乙型肝炎（CHB）患者的长期疗效。
方法：

我们确定了165拉米夫定耐药的慢性乙型肝炎患者对拉米夫定和阿德福韦长达5年的累计病毒学，血清学和生化结果。电阻型材使用的电话线探针检测，确定检测到的病毒血症的患者。不同的基准线和对治疗的病毒学参数的意义进行了分析。
结果：

后续的年龄中位数和持续时间分别为45.1个月和37.1个月。 HBV DNA不可检测性（<20 IU /毫升），ALT复常和肝炎的累积乙e抗原（HBeAg）血清转换长达5年分别为74.0％，95.1％和44.4％。其中一名病人取得了B型肝炎表面抗原（HBsAg）转阴。 5年累计耐药率阿德福韦为10.2％。在不同的基线和治疗病毒性参数，24周时HBV DNA <200 IU / mL的是与长期的病毒学抑制的机会增加（P <0.001，比值比为13.89，95％可信区间为3.90  -  49.46）。原发性非响应和高基线病毒滴度均在预测长期的病毒学结果没有用的。血清肌酐升高> 0.5 mg / dL的5年累计发生率是4.1％。
结论：

联合拉米夫定和阿德福韦长达5年实现率较为温和的病毒抑制，但只有10.2％的患者在性开发。 24周时HBV DNA <200 IU / mL的有利长期病毒学结果的预测，可用于辅助治疗的决定，继续拉米夫定和阿德福韦或切换到更有效的治疗。