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阿德福韦酯(ADV)主要用于慢性乙型肝炎(乙肝)初治和拉米夫定(LAM)耐药后的治疗。ADV耐药特别是多重耐药已成为临床常见且棘手的问题。乙肝初治患者使用ADV最常见的原发性耐药突变类型为rtA181V/T和rtN236T,最常见的多重耐药类型为rtL180M┼M204V┼A181V。RtA181V/T对恩替卡韦(ETV)和替诺福韦酯(TDF),rtN236T对LAM和ETV保持活性;多重耐药主要与LAM→ADV或LAM→ADV→ETV的序贯治疗有关。临床上应根据检出的耐药类型,首选LAM┼ADV、ETV┼ADV联合治疗或改用TDF。LAM耐药后,国内现有药物中应首选加用ADV,而非改用ETV。
Adefovir dipivoxil (ADV) is mainly used in the treatment of chronic hepatitis B (hepatitis B) naïve and lamivudine (LAM) -resistant. ADV resistance, especially multi-drug resistance has become a common and difficult clinical problem. The most common types of primary drug-resistant mutations for ADV in patients with hepatitis B are rtA181V / T and rtN236T, and the most common type of multi-drug resistance is rtL180M┼M204V┼A181V. RtA181V / T maintained activity against entecavir (ETV) and tenofovir disoproxil (TDF) and rtN236T against LAM and ETV; multiple drug resistance was associated with sequential therapy with LAM → ADV or LAM → ADV → ETV. Clinically based on the type of drug resistance detected, the preferred LAM┼ADV, ETV┼ADV combination therapy or switch to TDF. LAM resistance, the current domestic drug should be preferred plus ADV, instead of switching to ETV.