Abstract：Objective To observe the clinical efficts and safety of Tenofovir Disoproxil Fumarate (TDF) treating the poor effect of Lamivudine resistance combined with Adefovir Dipivoxil. Methods From January 2010 to December 2018, 49 patients with chronic hepatitis B with poor effects by Lamivudine resistance combined with Adefovir Dipivoxil, were chosen from the Handan Infectious Diseases Hospital in Hebei Province. Patients were divided into TDF group of 30 cases (Tenofovir Dipivoxil) and the control group of 19 cases (Entecavir combined Adefovir Dipivoxil) by random number table method. After changing the treatment plan, at the 12th, 24th and the 48th weeks after treatment, HBV DNA, renal function, blood calcium and phosphorus were tested to compare the treatment effects of the two groups at the above different stages. Results At the 12th week after treatment, the negative conversion rate of HBV DNA in TDF group was significantly higher than that in the control group (P ＜ 0.05), at the 24th and the 48th weeks after treatment, there was no significant statistic difference in the negative conversion rate of HBV DNA (P ＞ 0.05). At the 12th and the 24th weeks after treatment, the HBV DNA levels in TDF group were significantly lower than those in the control group (P ＜ 0.05), at the 48th week after treatment, there was no significant difference in HBV DNA level in the two groups (P ＞ 0.05). Compared with the pre-treatment level, HBV DNA in TDF group decreased significantly at the 12th, 24th and the 48th weeks after treatment (P ＜ 0.05), while in the control group, HBV DNA also decreased significantly at the 24th and the 48th weeks after treatment (P ＜ 0.05). Both groups had good tolerability without severe adverse reaction. Conclusion For patients with poor efficts of Lamivudine resistance combined with Adefovir Dipivoxil, within a short time TDF can quickly restrain virus replication and improve the negative conversion rate of HBV DNA, meanwhile with good safety.
[1] Hou J，Sun J，Xie Q，et al. Virological breakthrough and genotypic resistance in a roadmized，tontrolled，study on telbivudine treatment applying roadmap concopt in CHB：W76 interim analysis of effort study [J]. J Hepatol，2012， 56（Suppl2）：S203-S204.
[2] 刘黄巧，何清，唐奇远，等.单用替诺福韦酯与恩替卡韦联合阿德福韦酯挽救治疗慢性乙型肝炎对比观察[J].中西医结合肝病杂志，2017，27（5）：284-286.
[3] 中华医学会肝病学分会，中华医学会感染病学分会.慢性乙型肝炎防治指南（2015年版）[J].中国肝脏病杂志：电子版，2015，7（3）：1-18.
[4] Zhong JH，Ke Y，Zhu SL，et al. Adefovir dipivoxil is expensive than lamivdine and associated with similar prognosis in patients with hepatitis B virus-related hepatocellular carcinoma after radical resection [J]. Onco Targets Ther，2016，9：6897-6907.
[5] Ruggiero G，Marrone A，Rainone I，et al. Tenofovir disproxil fumarate monotherapy maintains HBV suppression ach-ieved by a “de novo” combination of lamivudine：a pilot study [J]. Infez Med，2016，24：278-286.
[6] Kim HJ，Park SK，Yang HJ，et al. Comparison of the clinical outcomes between antivirtual-naive patients treated with entecavir and lamivudine-resistant patients receiving adefovir add-onlamivudine combination treatment [J]. Clin Mol Hepatol，2016，22：350-358.
[7] Ke W，Zhang C，Liu L，et al. Cost-effectiveness analysis of tenofovir disoproxil fumarate for treatment of chronic hepatitis B in Chine [J]. Hepatol Int，2016，59：10244-10252.
[8] 蒲娟，王群茹.基于替诺福韦的挽救性疗法治疗核苷/核苷酸类似物耐药乙型肝炎患者长期疗效的回顾性研究[J].药物流行病学杂志，2017，26（8）：524-529.
[9] Hu CY，Liu YM，Liu Y，et al. Pharmacokinetics and tolerability of tenofovir disoproxil fumarate 300 mg once daily：an open-label，single-and multiple-dose study in healthy Chinese subjects [J]. Clin Ther，2013，35（12）：1884-1889.
[10] 李慧姣，王慧雯，杜漫，等.替诺福韦治疗NAs经治耐药或应答不佳的慢性乙肝患者临床效果及安全性[J].山东医药，2018，58（8）：57-59.
[11] 彭福江，陈福生，张天晓.替诺福韦酯和拉米夫定联合阿德福韦酯对乙型肝炎肝硬化疗效的比较[J].肝脏，2017，22（6）：535-538.
[12] European Association for the Study of the Liver. EASL 2017 Clinical practice guidelines on the management of hepatitis B virus infection [J]. J Hepatol，2017，67（2）：370-398.
[13] Liaw YF，Kao JH，Piratvisuth T，et al. Erratum to：Asian-Pacific consensus statement on the management of chronic hepatitis B：a 2012 update [J]. Hepatol Int，2012， 6（4）：809-810.
[14] Liu Corsa AC，Buti M，Cathcart AL，et al. No detectable resistance to tenofovir disoproxil fumarate in HBeAg+ and HBeAg- patients with chronic hepatitis B after 8 years of treatment [J]. J viral Hepatol，2017，24：68-74.
[15] Marcellin P，Gane EJ，Tsai N，et al. Seven years of treatment with tenofovir DF for chronic hepatitis B virus infection is safe and well tolerated and associated with sustained virological，biochemical and serological responses with no detectable resistance [J]. Hepatology，2013，58（s）：649A.
[16] Hou JL，Gao ZL，Xie Q，et al. Continued use of tenofovir disoproxil fumarate monotherapy or switching from adefovir dipivoxil results in potent viral suppression and a favorable safety profile in Chinese patients with chronic hepatitis B [J]. Hepatol Int，2014，8（S）：S147.
[17] Van Bommel F，de Man RA，Wedemeyer H，et al. Long-term efficacy of tenofovir monotherapy for hepatitis B virusmonoinfected hepatitis after failure of nucleoside/ nucleotide analogues [J]. Hepatology，2010，51：73-80.
[18] 李忠斌，邵清，李梵，等.替诺福韦酯单独与联合恩替卡韦挽救治疗恩替卡韦治疗拉米夫定经治慢性乙型肝炎失败患者疗效比较[J].肝脏，2016，21（3）：165-167.
[19] 吕丽娜，王浩.不同核苷类似物对HBV相关慢加急性肝衰竭患者预后的影响[J].医药论坛杂志，2018，39（3）：159-161.
[20] Han Y，Zeng A，Liao H，et al. The efficacy and safety comparison between tenofovir and entecavir treatment of chronic hepatitis B and HBV related cirrhosis：a systematic review and Meta-analysis [J]. Int Immunopharmacol，2017（42）：68-175.
[21] Chan HL，Shaikh J，Gupta S，et al. Renal function in nucleos（t）ide analog-treated patients with chronic hepatitis B：Asystematic literature review and network meta-analysis [J]. Adv Ther，2016，33：862-875.
2020, Vol. 17 
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