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基于替诺福韦的挽救性疗法治疗核苷/核苷酸类似物耐药乙型肝炎患者长期疗效的回顾性研究
A Retrospective Study of the Clinical Efficacy of Long term Tenofovir based Rescue Therapy in Chronic Hepatitis B Patients with Nucleoside/nucleotide Analogue resistant
  
DOI:
中文关键词:  乙型肝炎病毒  替诺福韦酯  恩替卡韦  拉米夫定  耐药性
英文关键词:Hepatitis B virus  Tenofovir disoproxil fumarate  Entecavir  Lamivudine  Drug resistance
基金项目:
作者单位
蒲娟 王群茹 ①达州市达川区人民医院(四川达州 635000)②成都军区总医院消化内科 
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中文摘要:
      摘 要 目的:研究长期采用基于替诺福韦酯(TDF)的挽救性疗法治疗核苷/核苷酸类似物耐药乙型肝炎患者的临床疗效。方法:采用回顾性研究方法,收集40例对核苷/核苷酸类似物耐药的乙型肝炎患者,在接受以TDF为基础的挽救治疗后的随访期间对患者进行分析,随访时长中位数为45个月。对病毒应答、乙型肝炎表面抗原水平的变化以及治疗期间的病毒学突破等因素进行了分析。结果:在以TDF为基础的挽救治疗0.5~4年,血清未检测到HBV DNA水平的患者的比例分别为68%, 78%,85%,88%,83%,81%,88%,100 %。TDF+LAM组与TDF+ETV组两组的病毒应答率无差异。与ADV耐药或ETV耐药HBV患者相比,在2年和3年时,LAM耐药HBV患者的乙肝表面抗原水平的平均减少量较大(P<0.05)。有2位ADV耐药HBV患者在基线时就发生了病毒学突破。结论:以TDF为基础的长期挽救治疗对接受LAM+ADV治疗、ETV+ADV治疗或ETV单独治疗失败的患者具有高效的病毒抑制效果。
英文摘要:
      ABSTRACT Objective:To study the clinical efficacy of long term tenofovir disoproxil fumarate (TDF) based rescue therapy in patients with chronic hepatitis B who were resistant to nucleoside/nucleotide analogs. Methods:The objects of this retrospective study were 40 patients with chronic hepatitis B who were resistant to nucleoside/nucleotide analogs. After receiving the TDF based rescue therapy and during a median of 45 months’ follow up, the analysis was performed for these 40 patients (range 14 99 months) . Viral response, changes in hepatitis B surface antigen levels from the baseline, and viral breakthrough during therapy were analyzed. Results:The proportion of patients with undetectable serum hepatitis B virus (HBV) DNA levels during TDF based rescue therapy were 68%, 78%, 85%, 88%, 83%, 81%, 88% and 100% respectively during 0.5 4 years. There were no differences in the viral response rate between the TDF plus LAM group and the TDF plus ETV group. The mean reduction from the baseline in hepatitis B surface antigen levels in patients with LAM resistant HBV was greater than the reductions in patients with adefovir dipivoxil (ADV) resistant or ETV resistant HBV at 2 and 3 years (P<0.05). However, two patients with ADV or ETV resistant HBV at the baseline developed viral breakthrough during TDF based rescue therapy. Conclusion:Long term therapy with a TDF based rescue regimen demonstrated high viral suppression in patients received LAM plus ADV combination therapy, ETV plus ADV combination therapy, or ETV monotherapy had failed.
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