拉米夫定耐药的慢性乙型肝炎患者的抢救策略比较

肝胆速递

http://www.ncbi.nlm.nih.gov/pubmed/22960601##
Antiviral Res. 2012 Aug 31. [Epub ahead of print]
Comparison of rescue strategies in lamivudine-resistant patients with chronic hepatitis B.
Zhao P, Wang C, Huang L, Xu D, Li T.
Source

Liver Failure Therapy and Research Center, Beijing 302 Hospital, Beijing 100039, China.
Abstract

Lamivudine (LAM) resistance now poses a major problem in the management of patients with chronic hepatitis B virus (HBV) infection. We retrospectively collected clinical data on chronic HBV-infected patients who had developed LAM resistance under de novo LAM monotherapy and subsequently took nucleos(t)ide analogs as rescue strategy in our hospital. From initiation of rescue therapies to January 2012, incidence of antiviral drug resistance was 23.67%, 18%, 6.94% and 0% (P=0.007) in the group of switching to adefovir dipivoxil (ADV) monotherapy, switching to entecavir (ETV) monotherapy, adding on ADV and switching to combination of ADV and ETV. At month 12, the median levels of serum HBV DNA were respectively 9300IU/mL, 4648IU/mL, 2054IU/mL and 100IU/mL (P<0.001), and the cumulative rates of serum ALT normalization were respectively 75%, 84%, 93% and 100% (P=0.003). Additionally, the strategy of switching to ADV monotherapy induced more single rtA181T mutations. In conclusion, switching to ADV monotherapy has been widely used in real-world clinical practice in China, however, due to the high incidence of drug resistance, switching to neither ADV nor ETV monotherapy is optimal when LAM resistance occurs; combination of ADV and ETV is most effective, whereas the strategy of adding on ADV is rational for most of LAM-resistant Chinese patients with chronic hepatitis B.

肝胆速递

抗病毒药物研究2012年08月31日。 [EPUB的提前打印]
在拉米夫定耐药的慢性乙型肝炎患者的抢救策略比较
王赵P，C，D，L，徐黄李T.
源

肝功能衰竭的治疗与研究中心，北京302医院，北京100039，中国。
抽象

拉米夫定（LAM）耐药慢性乙型肝炎病毒（HBV）感染患者的管理问题是一个重大的。我们回顾性收集谁制定了LAM耐药从头LAM单药治疗，随后核苷（酸）类似物作为我们医院的救援策略，对慢性HBV感染的患者的临床资料。从2012年一月开始复苏治疗，抗病毒耐药性的发生率是18％，23.67％，6.94％和0％（P= 0.007）切换到阿德福韦酯（ADV）单药治疗组，改用恩替卡韦（ETV）添加ADV单药治疗，并切换到ADV和ETV的组合。在12个月时，血清HBV DNA水平中位数分别为9300IU/mL，4648IU/mL，2054IU/mL和100IU/mL（P <0.001）和血清ALT正常化的累积率分别为75％，84％， 93％和100％（P= 0.003）。此外，该策略切换到ADV单药治疗的诱导较为单一rtA181T突变。总之，切换到ADV单药治疗已广泛应用于然而，在现实世界中的中国临床实践中，由于耐药性的高发病率，切换既不ADV或ETV单药治疗的最佳的LAM耐药发生时，组合的ADV和ETV是最有效的，而ADV添加的战略是合理的，对于大多数中国慢性乙型肝炎患者的抗LAM-

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