目的 優(yōu)化阿德福韋酯抗乙肝病毒治療策略，提高治療效果。方法 將42例HBeAg陰性慢性乙型肝炎患者依照HBV DNA載量分為2組，高病毒載量組22例，拉米夫定聯(lián)合阿德福韋酯治療；低病毒載量組20例，阿德福韋酯單藥治療，定期檢測HBV DNA、肝功能和乙肝病毒血清標志物（HBV-M）。結(jié)果 聯(lián)合治療組HBV DNA下降速度快，12周有效抑制率為72.7%，顯著高于單藥治療組（χ2=23.49，P＜0.001）；治療48周后兩組患者均獲得較高的病毒學(xué)應(yīng)答，HBV DNA有效抑制率（95.45% vs 95%）和測不到率（77.27% vs 80.90%）無統(tǒng)計學(xué)差異（P＞0.05）；治療12周及48周兩組ALT復(fù)常率無差異（P＞0.05），分別為40%、36.36%，90%、86.36%；兩組患者均未出現(xiàn)嚴重不良反應(yīng)。結(jié)論 對于HBV DNA載量較低的初治HBeAg陰性慢性乙型肝炎患者，阿德福韋酯單藥治療可獲得較好的療效，而HBV DNA≥6 log拷貝/mL的高病毒載量患者則需要聯(lián)合拉米夫定才能獲得較高的病毒及生化學(xué)應(yīng)答率。

Objective Optimizing the anti-hepatitis B of virus Adefovir dipivoxil treatment strategies to improve the therapeutic effect. Methods Patients (42) with HBeAg-negative chronic hepatitis B were divided into two groups according to HBV DNA: one with high viral genes group (n=22) which took Lamivudine and Adefovir dipivoxil, the other with low viral genes group (n=20) which took Adefovir dipivoxil monotherapy. HBV DNA, liver function test, and HBV serum marker (HBV-M) were detected periodically. Results Serum HBV DNA of taking Lamivudine and Adefovir dipivoxil group declined fast. HBV DNA suppression rate was 72.7% with treatment of 12 weeks, efficacy significantly higher than that in the monotherapy group ( χ2=23.49, P＜0.001). There were no significant difference between the two groups of HBV DNA suppression rate (95.45% vs 95%) and HBV DNA undetectable rate (77.27% vs 80.90%) after 48 weeks treatment (P＞0.05). There were no differences in ALT normalization rate between two groups after the treatment of 12 and 48 weeks (P＞0.05), they were 40%, 36.36%, 90%, and 86.36%. Two groups of patients did not occur serious drug-related events. Conclusion By initial treatment in lower HBV DNA genes, HbeAg-negative chronic hepatitis B patients with Adefovir dipivoxil monotherapy would get a good effect, but the combination of the Lamivudine and Adefovir dipivoxil was good for patients with HBV DNA≥6 log copies/mL to get a higher rate of viral and biochemical response.