Therapeutic Efficacy of Lamivudine Combined with Adefovir Dipivoxil in the Treatment of Lamivudine-re-sistant Chronic Hepatitis B Patients and Its Relationship with HBV Genotype / 中国药房

ABSTRACT

OBJECTIVE:To evaluate therapeutic efficacy of lamivudine(LAM)combined with adefovir dipivoxil(ADV) in the treatment of LAM-resistant chronic hepatitis B patients,and to study the relationship of therapeutic efficacy with hepatitis B virus(HBV)genotype. METHODS:A total of 101 LAM-resistant chronic hepatitis B patients selected during Dec. 2012 to Dec. 2014 were given LAM+ADV for 24 months at least. Regular outpatient visits or telephone follow-up were also performed. Polymerase chain reaction-reverse dot blot method was used to determine the HBV genotype. Chi-square test,Kaplan-Meier meth-od and Log-rank test were used to compare the virological response(HBV-DNA clearance rate)and biological response(ALT normalization rate and HBeAg seroconversion rate)among different genotypes at the 6th,12th,18th and 24th month of fol-low-up. RESULTS:The follow-up rate was 100%,without missed follow-up. Two genotypes were detected,including 34 pa-tients(33.7%)with genotype B and 67 patients(66.3%)with genotype C.At each time point mentioned above,the HBV-DNA clearance rates of 101 patients were 34.7%,55.4%,79.2% and 93.1%.At 6th month,HBV-DNA clearance rate and accumula-tive HBV-DNA clearance rate of genotype B were significantly higher than genotype C,with statistical significance(P<0.05). There was no statistical significance in HBV-DNA clearance rates or accumulative HBV-DNA clearance rates between different genotypes at other time points(P>0.05). At each time point mentioned above,ALT normalization rates of 101 patients were 40.6%,69.3%,82.2%,84.2%;there was no statistical significance in ALT normalization rates or accumulative ALT normaliza-tion rates between different genotypes(P>0.05). At each time point mentioned above,the HBeAg seroconversion rates of 101 patients were 10.9%,19.8%,24.8%,29.7%;there was no statistical significance in the HBeAg seroconversion rates or accu-mulative HBeAg seroconversion rates between different genotypes(P>0.05). CONCLUSIONS:LAM combined with ADV is ef-fective for LAM-resistant chronic hepatitis B patients. Moreover,the combination therapy can achieve earlier viological response in patients with genotype B than those with genotype C.