Two Types Of Antiviral Treatment In Different Stages Of Patients With Chronic Hepatitis B Efficacy

Objective:Comparative clinical efficacy of imports lamivudine ofmonotherapy with LAM and adefovir dipivoxil treatment of LAM withdrawalbut not relapse after YMDD mutation B and C genotype in patients with chronichepatitis B，and the right time to explore the combination therapy of lamivudineand adefovir dipivoxil for HBeAg-positive failure in patients withdecompensated cirrhosis. Methods: Method1：120cases of CHB patients withLAM withdrawal recurrence sequence of admission were randomly divided into58cases of LAM single drug treatment group, including30cases of genotype Band28cases of genotype C;62patients of LAM and ADV combinationtherapy group, including including32cases of genotype B and30cases ofgenotype C. The monotherapy group applications LAM100mg/d and the jointgroup based on the addition of ADV10mg/d were treated for one year,comparing its efficacy. Method2：The order of the60HBeAg-positive patientswith decompensated cirrhosis patients admitted to hospital were randomlydivided into two groups.Group A (initial joint) to lamivudine plus ADV initialcombination therapy; B group (to save coalition) Initial to lamivudine drug afterthe addition of adefovir dipivoxil salvage therapy. Treatments are48w, lamivudine100mg/d, adefovir dipivoxil10mg/d. The two groups beforetreatment0w, after treatment,4,12,24, and48w examinations of livingchemistry, serology, virology change and the Child-Pugh classification situation.Results: LAM of YMDD variation in relapse after withdrawal but not type band c genes in patients with chronic hepatitis b, After1year of treatment：single drug B, C group, joint B, and between C-type group was no significantdifference；ALT normalization combined group is higher than the monotherapygroup (83.87%vs55.17%, χ~2=11.753, p=0.001), there is a statisticallysignificant difference；HBV DNA undetectable rate (77.42%vs46.55%, χ~2=12.182, p=0.001), also statistically different；Joint group of11patients,HBeAg seroconversion monotherapy group (26.83%vs2.63%, χ~2=8.964, p=0.002), a statistically significant difference；10patients had virologicbreakthrough；The joint group does not appear virological breakthrough；HBeAg-positive patients with decompensated hepatitis b cirrhosis, group A(initial joint) HBV DNA load below the lower limit of detection rate andHBeAg serological negative rate of76.7%and53.3%, respectively, which wassignificantly higher than that in group B (to save the joint),43.3%and20%(χ~2=6.94and7.18, respectively, P values <0.05), the difference was statisticallysignificant；13cases of patients with genotype B HBV DNA was not detected inthe C genotype only48.9%can not be detected the48w when C genotype A, Btwo groups of HBV DNA undetectable rate of72.7%and40%, respectively,(χ~2value of5.07, P <0.05) difference was also statistically significant；Child-Pughscore A sub-group value (7.40±1.04) and group B (8.30±1.21) points (t=-3.10, P <0.05), a statistically significant difference.24w,48w, total bilirubingroup A (32.37±9.74) μmol/L,(25.30±7.93) μmol/L, B group (38.27±12.19) μmol/L,(31.50±8.80) micromol/L (t=-2.07,-2.863, P <0.05), the difference was statistically significant. Conclusion:1LAM monotherapy andADV in the treatment of LAM and LAM relapse after withdrawal but is notoccurrence of YMDD mutation b, c genotype of CHB patients withoutdiscrimination.2Relapse after the withdrawal of combination therapy LAM butnot YMDD mutation B, C genotype CHB patients can quickly significantlysuppressed HBV DNA replication in virology, biochemistry and HBeAgserological conversion has a better effect.3Combined initial LAM plus ADVfor HbeAg-positive patients with decompensated hepatitis b cirrhosis comparedto other NAs with the low prices, HBV DNA negative to go earlier, improvedliver function and advantages of Child-Pugh score exactly.4LC patients earlyapplications, can significantly improve the quality of life and survival ofpatients with delayed progression to end-stage liver disease, time, and thusreduce chance to do a liver transplant.5Such as the ability to combine HBVgenotyping assay, can greatly enhance the confidence of the treatment ofpatients with genotype B, has important guiding value. On the initial LC aloneLAM or ADV treatment failure patients, the combination of the two theremedial treatment also has a good effect.