阿德福韦酯联合拉米夫定治疗YMDD变异的慢性乙型肝炎疗效相关因素分析

目的研究分析影响阿德福韦（ADV）联合拉米夫定（LAM）治疗YMDD变异的慢性乙型肝炎疗效的相关因素。方法应用ADV联合LAM治疗71例YMDD变异的患者48周，采用Logistic回归分析影响疗效的相关因素。结果治疗48周时，HBVDNA转阴率为78．9％（56／71），ALT复常率为80．3％（57／71），HBeAg阳性患者HBeAg转阴或血清转换率为26．7％（12／45）；治疗24周和48周HBVDNA转阴、48周HBeAg转阴或血清转换和48周ALT复常者较相应时间点未转阴者的基线HBVDNA水平低（P〈0．05）；Logistic回归分析结果显示，基线HBVDNA低水平、24周HBVDNA转阴、12周YMDD变异转阴是48周获得较好疗效的相关因素。结论采用ADV联合LAM治疗YMDD变异的慢性乙型肝炎患者，其基线HBVDNA低水平、24周HBVDNA转阴、12周YMDD变异转阴是48周疗效较好的预测因素，发生病毒学突破而无生化学突破的患者早期联合治疗可获得更佳的疗效。

Correlation factors involved in therapeutic efficacy of 363adefovir dipivoxil in combination with lamivudine for chronic hepatitis B with YMDD mutation

Objective To investigate the correlation factors associated with the therapeutic efficacy of adefovir dip- ivoxil in combination with lamivudine for chronic hepatitis B with YMDD mutation. Methods 71 patients were enrolled and treated with adefovir dipivoxil in combination with lamivudine for 48 weeks. Logistic regression analysis was used to identify some possible correlation factors associated with therapeutic efficacy. Results After 48 wk treatment,the rate of undetectable HBV DNA, ALT normalization and HBeAg seroconversion was 78.9% （56/71 ）, 80.3% （57/71 ）and 26.7% （ 12/ 45）,respectively. Patients with undetectable HBV DNA at wk 24 and 48 of the treatment were found to have a lower baseline HBV DNA levels as compared with those who did not respond. Logistic regression analysis indicated that the baseline HBV DNA levels,undetectable serum HBV DNA at wk 24,and undetectable serum YMDD mutation at wk 12 were correlated factors of therapeutic efficacy at wk 48. Conclusion Complete response at wk 48 is closely associated with the lower baseline serum HBV DNA levels,HBV DNA negativity at wk 24 and undetectable serum YMDD mutation at wk 12. Early treatment with adefovir dipivoxil in combination with lamivudine for the patients with YMDD mutation without biochemical breakthrough can reach a better curative effect.