不同核苷类似物挽救的功效 乙型肝炎抗乙型肝炎的治疗

StephenW

792
EFFICACY OF DIFFERENT NUCLEOSIDE ANALOG RESCUE
THERAPY IN ENTECAVIR-RESISTANT CHRONIC HEPATITIS B
PATIENTS
Jin Shang1, Juan Zhou2, Huan Liu1, Lang Bai1 and Hong
Tang1, (1)Center of Infectious Diseases, West China Hospital,
Sichuan University, (2)Department of Laboratory Medicine,
West China Hospital, Sichuan University
Background: Entecavir (ETV) is recommended as first-line
anti-HBV treatment with low rate of drug resistance However,
a large amount of chronic hepatitis B patients initiated anti-
HBV treatment as lamivudine, telbivudine with low genetic
barriers in China, which leads to compensatory mutations and
increased the rate of ETV resistance Management of ETV
resistance in China is an essential clinical issue Methods:
Totally 1837 patients from 2011 to 2017 with nucleoside/
nucleotide analogues resistance were screened Among them
72 patients with ETV resistance receiving different rescue
therapy including ETV and adefovir (ADV) combination
therapy group (n=25), Tenofovir (TDF) monotherapy group
(n=27), ETV and TDF combination therapy group (n=20) were
analyzed Virologic, biochemical, and serologic responses
were compared in those three groups Results: Rate of ETV
resistance increased form 6 04 % in 2011 to 15 02% in 2017
In regard to rates of negative HBV DNA in 48 weeks, no
significant differences existed in in TDF monotherapy group
and TDF combination group (74 07% vs 70 00%), while ETV
and ADV group showed worst virologic response (28 00%)
TDF monotherapy and TDF combination therapy showed
similar decline of HBV DNA at weeks 12, 24, 48 There is no
significant difference in either rate of HBeAg clearance, ALT
normalization, rates of abnormal renal function between those
three groups Conclusion: ETV resistance gradually become
the major concern of drug resistance TDF monotherapy
showed comparable virologic response with TDF and ETV
combination therapy Thus, TDF monotherapy could be
preferred rescue therapy of ETV resistance while ETV and
ADV combination therapy is not recommended.

StephenW

792
不同核苷类似物挽救的功效
乙型肝炎抗乙型肝炎的治疗
耐心
金尚1，周娟2，刘欢1，郎白1和洪
唐1，（1）华西医院传染病中心
四川大学，（2）检验医学系，
四川大学华西医院
背景：推荐恩替卡韦（ETV）作为一线药物
抗HBV治疗且耐药率低
大量慢性乙型肝炎患者开始抗
HBV治疗拉米夫定，替比夫定遗传性低
中国的障碍，导致代偿性突变和
提高ETV抵抗率ETV管理
在中国耐药是必不可少的临床问题方法：
从2011年到2017年，共有1837例核苷/
筛选了核苷酸类似物的抗性
ETV耐药的72例患者接受了不同的救治
疗法包括ETV和阿德福韦（ADV）组合
治疗组（n = 25），替诺福韦（TDF）单药治疗组
（n = 27），ETV和TDF联合治疗组（n = 20）分别为
分析病毒学，生化和血清学反应
比较了这三组的结果：ETV的比率
阻力从2011年的6 04％增加到2017年的15 02％
关于48周内HBV DNA阴性的发生率，没有
TDF单一疗法组存在显着差异
和TDF组合组（74 07％对70 00％），而ETV
和ADV组的病毒学应答最差（28 00％）
TDF单药治疗和TDF联合治疗显示
在第12、24、48周时HBV DNA下降相似
HBeAg清除率，ALT的显着差异
正常化，那些之间的肾功能异常率
三组结论：ETV抵抗力逐渐成为
耐药性TDF单一疗法的主要关注
表现出与TDF和ETV相当的病毒学应答
因此，TDF单一疗法可能是
首选ETV抗性抢救疗法，而ETV和
不建议使用ADV联合疗法。