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目的探讨和评价阿德福韦对因拉米呋啶耐药而出现HBV再感染的肝移植病例的抗病毒疗效。方法9例存在拉米呋啶耐药株的肝移植术后HBV再感染者,治疗组(8例)予以改服阿德福韦酯,对照组(1例)加服泛昔洛韦治疗,并对两组病例的HBV DNA复制、乙肝血清学标志物、肝功、肾功等指标进行定期随访。结果治疗组6例(75％)于服药后2～3个月均实现HBV DNA的阴转,1例(12．5％)维持低水平状态(103copies／ml),且各有1例分别实现了HBsAg的阴转和HBeAg／HBeAb的血清学转换,肝功能均明显改善。对照组治疗前后各项指标无明显变化。结论对拉米呋啶耐药而导致的HBV再感染的肝移植病人,新一代核苷类药物阿德福韦,能够有效的抑制HBV变异株的复制,改善肝功能。
Objective To investigate and evaluate the antiviral efficacy of adefovir in liver transplantation cases resistant to reinfection with lamivudine. Methods Nine patients with Lamivudine resistant HBV re-infected after liver transplantation were treated with adefovir dipivoxil in treatment group (n = 8) and famciclovir (n = 10) in control group (n = HBV DNA replication, hepatitis B serological markers, liver function, renal function and other indicators were regularly followed up. Results Six patients (75%) in the treatment group achieved a negative conversion of HBV DNA 2 to 3 months after treatment, and one case (12.5%) maintained a low level of 103copies / ml Negative HBsAg and HBeAg / HBeAb seroconversion, liver function were significantly improved. The control group before and after treatment no significant changes in the indicators. Conclusions Adefovir, a new generation of nucleoside drugs, can effectively inhibit the replication of HBV mutants and improve liver function in HBV-infected liver transplant patients resistant to lamivudine.