阿德福韦酯治疗拉米夫定耐药的乙型肝炎病毒C基因型感染的疗效

Efficacy of adefovir dipivoxil in the treatment of lamivudine-resistant hepatitis B virus genotype C infection.

作者信息

Kim Do Young, Kim Hong Jeoung, Lee Chun Kyon, Suh Jeong Hun, Kim Dong Hwan, Cho Yong Suk, Won Sun Young, Park Byung Kyu, Park In Suh

机构信息

Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

出版信息

Liver Int. 2007 Feb;27(1):47-53. doi: 10.1111/j.1478-3231.2006.01407.x.

DOI:10.1111/j.1478-3231.2006.01407.x

PMID:17241380

Abstract

BACKGROUND AND AIMS

Adefovir dipivoxil (ADV) is a nucleotide analogue that is known to be effective for lamivudine-resistant hepatitis B virus (HBV) mutants as well as wild-type HBV. The aim of this study is to assess the efficacy of ADV against lamivudine-resistant genotype C HBV mutants.

METHODS

Thirty-five patients with breakthrough hepatitis due to lamivudine-resistant HBV received ADV 10 mg daily with discontinuation of lamivudine. Quantitative HBV DNA, HBeAg, liver function test including alanine aminotransferase (ALT) was checked every 4-12 weeks to evaluate the efficacy of ADV.

RESULTS

ADV was administered for a median of 48 weeks (range: 24-120 weeks). The rate of serum HBV DNA loss was 68.6%, 80.0%, 84.0%, and 88.2% at weeks 12, 24, 36, and 48, respectively. The rate of serum HBeAg seroconversion was 8.3% and 14.3% at weeks 24 and 48, respectively. The rate of serum ALT normalization at week 48 was 70.6%. Within 32 weeks after stopping ADV therapy, serum HBV DNA levels increased to a median of 378.9 pg/ml in 88.9% of patients, who were treated for a median of 40 weeks. Moreover, in some patients, the ALT level increased to more than five times the upper limit of normal.

CONCLUSIONS

Administration of ADV is an effective option for the treatment of patients with lamivudine-resistant genotype C HBV infection.

摘要

背景与目的

阿德福韦酯（ADV）是一种核苷酸类似物，已知对拉米夫定耐药的乙型肝炎病毒（HBV）突变体以及野生型HBV均有效。本研究旨在评估ADV对拉米夫定耐药的C基因型HBV突变体的疗效。

方法

35例因拉米夫定耐药HBV导致突破性肝炎的患者每日接受10mg ADV治疗，并停用拉米夫定。每4 - 12周检测定量HBV DNA、HBeAg、包括丙氨酸氨基转移酶（ALT）在内的肝功能检查，以评估ADV的疗效。

结果

ADV的中位给药时间为48周（范围：24 - 120周）。在第12、24、36和48周时，血清HBV DNA丢失率分别为68.6%、80.0%、84.0%和88.2%。在第24周和48周时，血清HBeAg血清学转换率分别为8.3%和14.3%。在第48周时，血清ALT恢复正常的比例为70.6%。在停止ADV治疗后的32周内，88.9%接受中位治疗时间为40周的患者血清HBV DNA水平中位数增加至378.9 pg/ml。此外，在一些患者中，ALT水平增加至正常上限的五倍以上。