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目的：观察阿德福韦酯短程联合拉米夫定治疗HBeAg（+）慢性乙型肝炎的疗效、病毒变异率、耐药发生率、HBV-DNA 转阴率（≤5×102 pies/ml）、HBeAg 血清转换率等指标的观察，探讨更合理、有效、价廉的治疗慢性乙型肝炎的方案。方法：选择 2008-2010 年我院门诊及住院的HBeAg（+）的慢性乙型肝炎病人，根据用药不同分为三组，进行为期24 月的治疗观察，予观察其肝肾功能、HBV-DNA、病毒变异、耐药发生率等指标的变化情况，并进行比较。结果：治疗24 个月时，三组患者显效率分别为90% (27/30)、46.88%(15/32)、44.82%(13/29)，三组显效率比较，2=53.982，P<0.05，显效率差异有统计学意义。总体有效率（显效+ 有效） A 组96.67%、B 组68.75%、C 组72.41%。三组患者第3、6、12、24 个月治疗效果均有差异（x2=18.746，P<0.05；x2=61.723，P<0.05； x2=26.821，P<0.05；x2=18.291，P<0.05）。三组患者第24 个月ALT、AST、TSB、ALB 和PT 等肝肾功能指标比较，均有差异（t=2.107， P<0.05；t=3.113，P<0.01；t=2.764，P<0.01；t=2.155，P<0.01）。治疗结束时，三组HBeAg 血清转换例数比较，2=8.220，P<0.05，三组 HBeAg 血清转换情况差异有统计学意义。采用t 检验比较三组第3、6、12、24 个月HBV-DNA 中位值，均有差异（t=1.997，P<0.05； t=2.982，P<0.01；t=2.651，P<0.01；t=3.113，P<0.01）。阿德福韦酯短程联合拉米夫定组共发生3 例不良反应，单用拉米夫定组发生4 例不良反应，单药使用阿德福韦酯发生不良反应为3 例。结论：阿德福韦酯短程联合拉米夫定治疗慢性乙型肝炎疗效和安全性均较高，用药方案具有合理性、有效性，效价比高，适合临床应用。

英文摘要:

Objective: To explore the clinical effecttivess, mutation and resistance rate, the rate of serum HBV-DNA turned to negative and HBeAg serum conversion rate of Adefovir Dipivoxil combined with Lamivudine for short application to HBeAg-positive chronic hepatitis B patients, to find the effective and safe chemotherapy treatment. Methods: Retrospective analysis of 91 patients with HBeAg-positive chronic hepatitis B patients from Jan. 2008 to Dec. 2010 in our hospital divided to three groups by using different drugs To compared the clinical effecttivess, mutation and resistance rate, the rate of serum HBV-DNA turned to negative and HBeAg serum conversion rate for the three groups for follow-up 24 months. Results: The effectiveness rates of the three groups were 90%(27/30), 46.88%(15/32)、44.82%(13/29).They were statistical different significantly（x2=53.982，P<0.05）. The total effective power of three groups 96.67%, 68.75%, 72.41%. The total effective power of three groups for 3rd month, 6th month, 12th month and 24th month follow-up were statistical different significantly （x2=18.746，P<0.05；x2=61.723，P<0.05；x2=26.821，P<0.05；x2=18.291，P<0.05）. ALT, AST, TSB, ALB and PT of the three groups were statistical different significantly（t=2.107，P<0.05；t=3.113，P<0.01；t=2.764，P<0.01；t=2.155，P<0. 01）for 24th month after treatment. HBeAg serum conversion rate of three groups were statistical different significantly (x2=8.220，P<0. 05). The mean value of the rate of serum HBV-DNA turned to negative were statistical different significantly（t=1.997，P<0.05；t=2.982， P<0.01；t=2.651，P<0.01；t=3.113，P<0.01）. There were 3 cases for adverse reactions to drug in Adefovir Dipivoxil combined with Lamivudine group, 4 cases in Lamivudine group and 3 cases in Adefovir Dipivoxil group. Conclusion: The clinical effecttivess and safty of Adefovir Dipivoxil combined with Lamivudine for short application to HBeAg-positive chronic hepatitis B patients are higher. The therapeutic schemes is reasonableness, effectiveness and the total output is higher. It is suitable for clinical application.

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