阿德福韦酯初治耐药与阿德福韦酯挽救治疗再耐药患者的临床特征比较.pdf

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1、27·临床论著·阿德福韦酯初治耐药与阿德福韦酯挽救治疗再耐药患者的临床特征比较李平张佳娟张馨杨志国高蕾汪茂荣【摘要】目的研究阿德福韦酯(ADV)初治耐药和ADV挽救治疗拉米夫定(LAM)耐药者再耐药的临床和病毒学特点。方法对ADV治疗过程中出现病毒突破的患者进行耐药位点的检测。明确耐药位点患者中单用ADV者37例，LAM耐药后换用ADV的患者40例，患者发生病毒学突破时留取血清标本，行血生化检测并收集其临床资料。结果ADV初治耐药(ADVr)组和ADV挽救LAM耐药再耐药(LAMr／ADVr)组患者临床特征中的平均年龄、性别分布、HBsAg定量、HBVDNA载量、基因型分布、肝功能指标(T

2、Bil、ALT和AST水平)等差异均无统计学意义(P均>0．05)，但两组患者的HBeAg阳性率差异具有统计学意义(57．5％VS83．8％：=6．339，P=0．012)。在病毒学特征方面，N236T变异、A181T+N236T变异更多发生于ADVr组患者中，而LAMr／ADVr组患者的耐药模式更加复杂。结论LAM耐药后换用ADV治疗同样会导致病毒耐药的发生，临床特征和ADV初治耐药相近，但引起HBV变异模式的复杂化。【关键词】病毒性肝炎，乙型；核苷(酸)类似物；耐药；变异；临床特征Analysisofclinicalcharacteristicsbetweenpatientswitha

3、defovir-naiveresistantandadefovir-rescureresistantLIPingZHANGJiajuan，ZHANGXin，YANGZhiguo，GAOLei,WANGMaorong．*LiverDiseasesCenterofPLA．The81thHospitalofPLA．Nanjing210002．ChinaCorrespondingauthor．"LIPing,Email．"leep2002@163．corn[Abstract]ObjectiveTostudytheclinicalandvirologicalcharacteristicsofadef

4、ovirdipivoxil(ADV)denovoresistanceandADVrescuetherapylamivudine(LAM)resistance．MethodsPatientstreatedwithADVweredetecteddrugresistancewhenoccurringviralbreakthrough．Therewere37ADV-naivepatientsand40ADVrescueLAMresistantpatientsenrolledinthisstudy．Theirconventionalbiochemicaltestsresultsandclinical

5、datawerecollected．ResultsTheaverageage，sexdistribution，HBsAgquantification，HBVDNAload，genotypes，liverfunction(TBil，ALTandASTlevels)betweenthetwogroupsshowednosignificantdifferenceall>0．05)．TheproportionofHBeAg—positivewassignificantlydifferentinthetwogroups(57．5％VS83．8％；=6．339，P=0．012)．Invirologic

6、alcharacteristics，N236TmutationandA181T+N236TmutationweremoreoftenseeninADVrgroup，LAMr／ADVrgrouphadmorecomplexresistancepatterns．ConclusionsSwitchingtoADVtherapyafterLAMresistancecouldalsocausetheoccurrenceofviralresistance，theclinicalcharacteristicsweresimilartoADVdenovoresistance，buttheHBVmutati

7、onpaRemsweremorecomplex．[Keywords】HepatitisBvirus；Nucleos(t)ideanalogues；Resistance；Mutation；ClinicalcharacteristicsD0I：lO．3877／cma．j．issn．1674—1358．2014．02．007基金项目：国家科技重大专项子课题(No．2008ZX10002004—001—024)作者单位：2100