服润众恩替两年一个半月了，DNA还是3次方，伤心。

lai23

知晓乙肝有近三十年了，64年生，11年1月发病，DNA 7.29*10个7次方，E抗原1190，ALT 150，AST 78。服恩替一个月DNA降为3.17*10个5次方，ALT 176，AST 82，E抗原1400.服恩替整二个月，DNA为1.29*10个5次方，E抗原1224，ALT 90，AST 45.以后一直坚持每天晚10时服药从未间断，可怜两年多来刚拿到报告单DNA 1.91*10个3次方，E抗原还有697这么高，ALT 34，AST 25. 我知道继续服药是我唯一的出路，何时DNA、E抗原才能转阴？加服阿德或恩替2粒？还是坚持一粒与病毒扛到底？

xmfish2011

早就该加服用阿德了吧

172288625

着急什么呢。一直吃下去~不就是钱么？吃下去不发病就好了~别想治愈~希望越大失望越大~

StephenW

xmfish2011 发表于 2013-3-6 16:02
早就该加服用阿德了吧

对恩替卡韦部分响应患者, 研究显示，阿德福韦+恩替卡韦不是有效的.

anhuidsy95

lyq2003526

应答不佳者：2恩替+阿德 效果大于 恩替+阿德 大于 单恩替。不一定是耐药。
最好方案是 恩替+替诺  或 单替诺。基本上dna都会阴转。概率是90%+

MP4

StephenW 发表于 2013-3-6 19:30
对恩替卡韦部分响应患者, 研究显示，阿德福韦+恩替卡韦不是有效的.

可有文献网址?
只能替诺了

StephenW

回复 MP4 的帖子

http://www.ncbi.nlm.nih.gov/pubmed/23010744
Dig Dis Sci. 2012 Nov;57(11):3011-6. doi: 10.1007/s10620-012-2402-2. Epub  2012 Sep 26.
Tenofovir monotherapy and tenofovir plus entecavir combination as rescue therapy for entecavir partial responders.Yip B, Chaung K, Wong CR, Trinh HN, Nguyen HA, Ahmed A, Cheung R, Nguyen MH.
SourceDivision of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA. [email protected]

AbstractBACKGROUND AND AIMS: Despite high potency, a significant proportion of patients treated with entecavir achieve only partial viral suppression. Our goal was to examine the complete viral suppression rate (undetectable HBV DNA PCR levels) with alternative therapies in such patients.
METHODS: We retrospectively studied 42 consecutive patients with partial response to entecavir (detectable HBV DNA at ≥12 months of therapy) who were treated at three clinics with rescue therapies: entecavir + adefovir (n = 5), tenofovir (n = 6), and entecavir + tenofovir (n = 31). Antiviral resistance was excluded by negative mutation analysis and/or absence of virologic breakthrough (increase >1 log(10)IU/mL from nadir).
RESULTS: All patients were Asian and 57 % were male with a median age of 36 (22-64) years. Only a few patients had prior exposure to lamivudine (7 %) or adefovir (7 %). Almost all patients (95 %) had positive HBeAg. Overall, the complete viral suppression rate was 79 %, and the alanine aminotransferase normalization rate was 83 % in entecavir partial responders after 6 months on rescue therapies. Cumulative complete viral suppression rates were significantly different (P = 0.0164) among the entecavir + adefovir, tenofovir, and entecavir + tenofovir treatment groups at 6 months (20 vs. 83 vs. 83 %, respectively) and 12 months (20 vs. 100 vs. 97 %). All three patients without complete viral suppression on entecavir + adefovir became aviremic 6 months after switching to entecavir + tenofovir.
CONCLUSIONS: Virologic response to entecavir + tenofovir combination therapy and tenofovir monotherapy appeared to be similar in most patients, but not with the entecavir + adefovir combination.

累计完成病毒的抑制率有显着性差异（P =0.0164）之间的恩替卡韦+阿德福韦，替诺福韦和恩替卡韦+替诺福韦治疗组
在6个月（20％和83％比83％），在
12个月（20％和100%比97％）。

MP4

核苷和核苷酸类药物治疗慢性乙型肝炎的耐药及其管理
http://www.hbvhbv.info/forum/for ... fromuid-320872.html

MP4

StephenW 发表于 2013-3-6 23:29
回复 MP4 的帖子

http://www.ncbi.nlm.nih.gov/pubmed/23010744

不错，你资料提示
恩替+替诺  或 单替诺疗效相似，因此成本上没必要叠恩替了，直接替诺或EM就行