ラミブジン耐性B型肝硬変に対しアデフォビル併用療法を開始し，4年後にアデフォビル耐性遺伝子変異によるbreakthrough hepatitisを認めた1例

症例は49歳男性．1999年よりB型慢性肝炎に対してラミブジン治療が行われていた．2004年に肝炎増悪を伴ったHBV DNAのYVDD変異が出現したため，ラミブジン・アデフォビル併用療法が開始された．2008年7月よりウイルス量が増大し，肝炎の再増悪が出現した．アデフォビル耐性株によるbreakthrouh hepatitisを疑い，エンテカビル・アデフォビル併用療法に変更し，ウイルス量の低下とともに肝炎改善が得られた．HBV DNA塩基配列の解析にてA181V/T変異，N236T変異が確認され，アデフォビル耐性株によるbreakthrouh hepatitisと診断した．ラミブジン耐性ウイルスに対するアデフォビル併用療法の経過中に，アデフォビル耐性ウイルスによるbreakthrouh hepatitisを発症した報告は極めて稀少であり，文献的考察を加え報告する．

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