2018 年第 5 期 第 13 卷

替诺福韦酯联合拉米夫定治疗获得性免疫缺陷综合征合并乙型肝炎病毒感染的临床效果研究

Clinical effect of tenofovir dipivoxil combined with lamivudine on acquired immunodeficiency syndrome complicated with hepatitis B virus infection

作者：夏华

英文作者：

单位：110024沈阳医学院附属中心医院感染科

英文单位：

关键词：获得性免疫缺陷综合征；乙型肝炎病毒；替诺福韦酯；拉米夫定

英文关键词：

• 摘要：

• 目的    探讨替诺福韦酯联合拉米夫定治疗获得性免疫缺陷综合征(艾滋病)合并乙型肝炎病毒（HBV）感染的效果。方法    选取2013年6月至2016年6月沈阳医学院附属中心医院收治的艾滋病合并HBV感染患者60例，完全随机分为观察组与对照组，各30例。对照组在常规治疗基础上口服拉米夫定治疗，观察组在对照组基础上口服替诺福韦酯治疗。比较2组患者治疗6、12个月后血清HBV-DNA含量、丙氨酸转氨酶复常率、HBV-DNA低于检测下限率和治疗12个月后人类免疫缺陷病毒（HIV）-RNA转阴率。结果    治疗6、12个月后，2组患者血清HBV-DNA载量明显低于治疗前［对照组：（4.7±1.2）、（3.4±1.1）拷贝/ml比（5.0±1.1）拷贝/ml；观察组：（3.2±1.2）、（1.9±1.1）拷贝/ml比（5.0±1.1）拷贝/ml］，且观察组明显低于对照组（均P＜0.05）。治疗6、12个月后，观察组患者丙氨酸转氨酶复常率和HBV-DNA低于检测下限率均明显高于对照组（均P＜0.05）。治疗12个月后，观察组HIV-RNA转阴率明显高于对照组［90.0%（27/30）比73.3%（22/30）］（P＜0.05）。结论    替诺福韦酯联合拉米夫定治疗艾滋病合并HBV感染患者，能有效抑制HBV和HIV复制，降低血清HBV载量，有效控制患者病情。

• 【Abstract】Objective    To observe the clinical effect of tenofovir dipivoxil combined with lamivudine on acquired immunodeficiency syndrome（AIDS） complicated with hepatitis B virus（HBV） infection. Methods    Sixty AIDS patients with HBV infection in Central Hospital Affiliated to Shenyang Medical College from June 2013 to June 2016 were randomly divided into observation group and control group, with 30 cases in each group. The control group took lamivudine; the observation group took lamivudine and tenofovir dipivoxil. Serum HBV-DNA content and alanine aminotransferase level were determined 6, 12 months after treatment. Human immunodeficiency virus(HIV)-RNA negative rate was tested 12 months after treatment. Results    Serum HBV-DNA content 6, 12 months after treatment significantly decreased compared to that before treatment in both groups［control group： （4.7±1.2）,（3.4±1.1）copies/ml vs （5.0±1.1）copies/ml； observation group： （3.2±1.2）,（1.9±1.1）copies/ml vs （5.0±1.1）copies/ml］ and there were significant differences between groups（P＜0.05）. Recovery-to-normal rate of alanine aminotransferase and below-lower-limit rate of HBV-DNA 6, 12 months after treatment in observation group were significantly higher than those in control group（P＜0.05）. HIV-RNA negative rate 12 months after treatment in observation group was significantly higher than that in control group［90.0%（27/30） vs 73.3%（22/30）］（P＜0.05）. Conclusion    Lamivudine combined with tenofovir dipovoxil treating AIDS complicated with HBV infection can effectively inhibit replication of HBV and HIV, lower serum HBV content and improve the disease condition.

  【Key words】Acquired immunodeficiency syndrome；Hepatitis B virus；Tenofovir dipivoxil；Lamivudine