The Efficacy Of Adefovir Dipivoxil In The Treatment Of Patients With Lamivudine-related Hepatitis B Viral YIDD Or YVDD Mutant Infection

Background:The mutation will come out if long time therapy by using LAM,one kinds of nucleosideanalogues.The mode called HBV DNA YMDD is the major one for theprinciple.However,after lots of studies and researches,more and more results displaythat addying ADV for the later therapying is one sensibly seclection,and which issuperior than using only ADV,and the risk of takeing place mutationg the second timewill be relatively small. Most researches pay more attention on the objects includingevery who had happened HBV DNA YMDD mutation, Howerve,we can also find thatthe objects will be distinguished by whether the variant had been with wild strains ornot on our clinic works.Of course that the former is less than the later under the superiorselection principle.Whether there is distinguish between the two HBV DNA YMDDmutation modes or not, we can’t see it, because no correlated reports come out atpresent.Today,our works made on it,In views of economy，there will maybe do somefavors for a super therapeutic regimen. Objective：To observe the3month-efficacy of adefovir dipivoxil in the treatment of patientswith lamivudine-related hepatitis B about HBV DNA YIDD or YVDD mutant infection.Methods：30lamivudine-resistant chronic hepatitis B patients were treated by combination ofadefovir dipivoxil and lamivudine in this study for three months. The serum HBVDNA was detected by fluorescent quantitation–PCR.Results：The HBV DNA YIDD or YVDD mutant infection was found in21patients, and themixed mutant and wild viral infection was found in9; the baseline of serum HBV DNA,ALT and AST in mutant group were6.2±1.4lgcopies/ml,139.8±153.2U/L and119.0±32.1U/L,respectively. After3month treatment, they dropped to2.3±2.3lgcopies/ml,54.5±44.7U/L and39.8±32.1U/L, respectively; the baseline of them inmixed infection group were6.0±1.9lgcopies/ml,144.7±128.2U/L and114.2±131.1U/L,respectively and after3month treatment, they dropped to2.4±2.4lgcopies/ml,55.8±53.2U/L and42.8±32.3U/L, respectively（p>0.05）; the HBV DNA loss inmutant infection was found in90.5%, serum ALT normalization in90.5, and the HBVDNA loss and ALT normalization in mixed infection were88.9%and77.8%,respectively; no HBeAg seroconversion was found in mutant infection group, while37.5%(3/8) had HBeAg seroconversion in mixed infection group.Other two groups named V and MV: The former group of basal line of serum HBV DNA、AST and ALTare6.5±1.3lgcopies/ml,0.2±97.4U/L and63.1±49.5U/L respectively;After3monthstherapy with addindg adefovir(1piece for1day) and each items are dropping to2.6±2.4lgcopies/ml,5.7±31.5U/L and35.6±11.1U/L respectively; The later group: The basalline of each items are6.8±1.7lgcopies/ml,26.4±117.2U/L and183.6±144.0U/Lrespectively; After3months therapy with adding adefovir,each items are2.7±2.5lgcopies/ml copies/ml,9.4±62.6U/L and61.8±31.9U/L respectively. Also there is nosignificant difierence between the two groups after calculation and analysising on theHBV DNA and ALT （Two independent samplerts of test：thbvdna=-0.92,p>0.05；tALT=0.11，pALT>0.05；）.Othewise there is a significant difierence display by the AST(pAST=0.04).Conclusion：From the statistical results of the mutant group and mixed mixed infection group,wecome to a conclusion that the conbination of lamivudine and adefovir dipivoxil therapyfor patients with hepatitis B mutant or mutants and wild viral infection can get the sameshort-term efficacy. So we make a first touch that maybe there is no significantdiference on the therapy efficacy between HBV DNA YIDD or YVDD infection andmixed mutant with wild infection.However,there will be some diference if ourexperiment take some changes like adding more volunteers、prolonging the reviewingtime and/or detecting HBV DNA YMDD after adding adefovir after three months.