Moon Won, Choi Moon Seok, Moon Yu Mi, Paik Seung Woon, Lee Joon Hyoek, Koh Kwang Cheol, Yoo Byung Chul, Rhee Jong Chul, Shim Sang Goon
Department of Medicine, Gastrointestinal Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Hepatol. 2005 Jun;11(2):125-34.
BACKGROUND/AIMS: Adefovir dipivoxil is effective in patients with lamivudine-resistant hepatitis B virus (HBV). However, little is known about its role in Korean patients with decompensated liver cirrhosis. We retrospectively evaluated the efficacy and safety of adefovir dipivoxil in patients with decompensated liver cirrhosis with lamivudine resistance, and we compared this to the patients having compensated liver disease.
The patients with lamivudine-resistant chronic liver disease were enrolled and they received adefovir dipivoxil 10 mg daily. The clinical course and the biochemical and virological response of the decompensated cirrhosis group were compared with those of the patients with compensated liver disease group.
One-hundred and one patients (the decompensated cirrhosis group, n=53; the compensated liver disease group, n=48) were evaluated. During the following up, 13 patients in the decompensated group and 4 patients in the compensated group dropped out of the treatment (P=0.011). After adefovir treatment, the proportion of patients with serum HBV DNA below 0.5 pg/mL in the decompensated group was less than that in the compensated group (50.9% vs. 83.3%, P=0.001), but the rates of normalized ALT, HBeAg loss and HBeAg seroconversion did not differ. The change of the Child-Pugh score in the decompensated group was 9.1 +/- 1.8 to 6.9 +/- 1.6 (P<0.001). The biochemical response in decompensated group was slower than that in the compensated group. Renal toxicity was not observed in either group.
These results suggest that adefovir dipivoxil would be an effective and safe treatment for patients with decompensated liver cirrhosis with lamivudine resistance, but its effect might be limited and slower for decompensated cirrhosis.
背景/目的：阿德福韦酯对拉米夫定耐药的乙型肝炎病毒（HBV）患者有效。然而，对于其在韩国失代偿期肝硬化患者中的作用知之甚少。我们回顾性评估了阿德福韦酯在拉米夫定耐药的失代偿期肝硬化患者中的疗效和安全性，并将其与代偿期肝病患者进行比较。
纳入拉米夫定耐药的慢性肝病患者，并给予每日10mg阿德福韦酯治疗。比较失代偿期肝硬化组与代偿期肝病组的临床病程、生化及病毒学反应。
共评估了101例患者（失代偿期肝硬化组，n = 53；代偿期肝病组，n = 48）。随访期间，失代偿组有13例患者、代偿组有4例患者退出治疗（P = 0.011）。阿德福韦治疗后，失代偿组血清HBV DNA低于0.5 pg/mL的患者比例低于代偿组（50.9%对83.3%，P = 0.001），但ALT正常化率、HBeAg消失率和HBeAg血清学转换率无差异。失代偿组Child-Pugh评分从9.1±1.8降至6.9±1.6（P<0.001）。失代偿组的生化反应比代偿组慢。两组均未观察到肾毒性。
这些结果表明，阿德福韦酯对拉米夫定耐药的失代偿期肝硬化患者是一种有效且安全的治疗方法，但其对失代偿期肝硬化的疗效可能有限且较慢。
