OBJECTIVE:To evaluate therapeutic efficacy of lamivudine(LAM)combined with adefovir dipivoxil(ADV) in the treatment of LAM-resistant chronic hepatitis B patients,and to study the relationship of therapeutic efficacy with hepatitis B virus(HBV)genotype. METHODS:A total of 101 LAM-resistant chronic hepatitis B patients selected during Dec. 2012 to Dec. 2014 were given LAM+ADV for 24 months at least. Regular outpatient visits or telephone follow-up were also performed. Polymerase chain reaction-reverse dot blot method was used to determine the HBV genotype. Chi-square test,Kaplan-Meier meth-od and Log-rank test were used to compare the virological response(HBV-DNA clearance rate)and biological response(ALT normalization rate and HBeAg seroconversion rate)among different genotypes at the 6th,12th,18th and 24th month of fol-low-up. RESULTS:The follow-up rate was 100%,without missed follow-up. Two genotypes were detected,including 34 pa-tients(33.7%)with genotype B and 67 patients(66.3%)with genotype C.At each time point mentioned above,the HBV-DNA clearance rates of 101 patients were 34.7%,55.4%,79.2% and 93.1%.At 6th month,HBV-DNA clearance rate and accumula-tive HBV-DNA clearance rate of genotype B were significantly higher than genotype C,with statistical significance(P<0.05). There was no statistical significance in HBV-DNA clearance rates or accumulative HBV-DNA clearance rates between different genotypes at other time points(P>0.05). At each time point mentioned above,ALT normalization rates of 101 patients were 40.6%,69.3%,82.2%,84.2%;there was no statistical significance in ALT normalization rates or accumulative ALT normaliza-tion rates between different genotypes(P>0.05). At each time point mentioned above,the HBeAg seroconversion rates of 101 patients were 10.9%,19.8%,24.8%,29.7%;there was no statistical significance in the HBeAg seroconversion rates or accu-mulative HBeAg seroconversion rates between different genotypes(P>0.05). CONCLUSIONS:LAM combined with ADV is ef-fective for LAM-resistant chronic hepatitis B patients. Moreover,the combination therapy can achieve earlier viological response in patients with genotype B than those with genotype C.

Objective To analyze the short-term survival and prognostic quality of life of patients with liver cirrhosis complicated by bacterial infection. Methods This study collected and analyzed 300 patients with liver cirrhosis complicated with infection who were hospitalized in the First Affiliated Hospital of Hebei North University, and followed up to discuss their survival and quality of life. Results In this study, the top two causes of infection were spontaneous bacterial peritonitis (60.67% of patients) and pneumonia (50.67% of patients). The second causes were urinary tract infections (15.33%), gastrointestinal infections (12.33%), and other causes. There was no statistically significant difference between male and female patients (P>0.05). In addition, the proportion of hospital infections was 71.00%, and there was no statistically significant difference between male and female patients (P>0.05). A total of 353 strains of pathogenic bacteria were isolated in this study (73.37% of patients with hospital infections). The distribution analysis of pathogenic bacteria showed that the highest proportion of ECO was 35.98%, followed by Klebsiella pneumoniae (18.98%). The distribution trend of 259 strains of pathogenic bacteria among hospital patients was consistent with that of all strains, and the difference was not statistically significant (P>0.05). Gram negative bacteria accounted for 79.60% (281/353) of all detected strains, of which Escherichia coli was mostly detected in patients with spontaneous bacterial peritonitis, Klebsiella Pneumoniae (KPN) and Pseudomonas aeruginosa (PAE) were mostly detected in patients with pneumonia, and Enterococcus (ENF) was mostly detected in patients with urinary tract infection; Among gram-negative bacteria, Staphylococcus epidermidis (SEP) and Staphylococcus aureus (SAU) are mostly found in patients with other infectious causes (blood flow infection, etc.) , and Streptococcus (STR) accounts for a high proportion in patients with Spontaneous bacterial peritonitis. In this study, 9 cases of death prognosis were detected during follow-up, and there was no statistically significant difference in the detection of death prognosis between different bacterial strains in both genders, as well as the difference in detection of death prognosis between hospital infections and out of hospital infections in both genders (P>0.05). There was no statistically significant difference in the detection of death prognosis between males and females due to different causes of infection, P>0.05. The quality of life scores of 291 surviving patients were compared between baseline and follow-up, indicating an increase in follow-up scores, especially in the dimensions of physiological function and physical pain. There was no statistically significant difference between different bacterial strains, infection causes, and hospital/non hospital infections (P>0.05) . Conclusion Spontaneous bacterial peritonitis and pneumonia are the main causes of infection that deserve special attention, and the main pathogens of infection are Gram negative bacteria. Targeted treatment and rehabilitation should be provided for patients with liver cirrhosis complicated by infection. At the same time, the proportion of hospital infections is relatively high, and attention should be paid to, prevention and control measures should be implemented as well.