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1、27·臨床論著·阿德福韋酯初治耐藥與阿德福韋酯挽救治療再耐藥患者的臨床特征比較李平張佳娟張馨楊志國(guó)高蕾汪茂榮【摘要】目的研究阿德福韋酯(ADV)初治耐藥和ADV挽救治療拉米夫定(LAM)耐藥者再耐藥的臨床和病毒學(xué)特點(diǎn)。方法對(duì)ADV治療過(guò)程中出現(xiàn)病毒突破的患者進(jìn)行耐藥位點(diǎn)的檢測(cè)。明確耐藥位點(diǎn)患者中單用ADV者37例，LAM耐藥后換用ADV的患者40例，患者發(fā)生病毒學(xué)突破時(shí)留取血清標(biāo)本，行血生化檢測(cè)并收集其臨床資料。結(jié)果ADV初治耐藥(ADVr)組和ADV挽救LAM耐藥再耐藥(LAMr／ADVr)組患者臨床特征中的平均年齡、性別分布、HBsAg定量、HBVDNA載量、基因型分布、肝功能指標(biāo)(T
2、Bil、ALT和AST水平)等差異均無(wú)統(tǒng)計(jì)學(xué)意義(P均>0．05)，但兩組患者的HBeAg陽(yáng)性率差異具有統(tǒng)計(jì)學(xué)意義(57．5％VS83．8％：=6．339，P=0．012)。在病毒學(xué)特征方面，N236T變異、A181T+N236T變異更多發(fā)生于ADVr組患者中，而LAMr／ADVr組患者的耐藥模式更加復(fù)雜。結(jié)論LAM耐藥后換用ADV治療同樣會(huì)導(dǎo)致病毒耐藥的發(fā)生，臨床特征和ADV初治耐藥相近，但引起HBV變異模式的復(fù)雜化?！娟P(guān)鍵詞】病毒性肝炎，乙型；核苷(酸)類似物；耐藥；變異；臨床特征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基金項(xiàng)目：國(guó)家科技重大專項(xiàng)子課題(No．2008ZX10002004—001—024)作者單位：2100
