干扰素或阿德福韦酯治疗HBeAg阳性慢性乙型肝炎2年的成本-疗效比较  

Therapeutic effect and cost of two-year therapy chronic hepatitis B： a comparative study with interferon compared to adefovir in patients with

作　　者：王桂爽[1] 李蔚莉[1] 蔡晧东[1] 

机构地区：[1]北京地坛医院感染科,100015

出　　处：《中华传染病杂志》2011年第2期87-93,共7页Chinese Journal of Infectious Diseases

摘　　要：【摘要】目的比较IFNr2b（安福隆）与阿德福韦酯（贺维力）用于初治HBeAg阳性慢性乙型肝炎（慢乙肝）2年疗效、患者耐受性和治疗成本。方法对门诊治疗的慢乙肝初治患者，根据患者意愿决定初治药物：34例患者选择重组人IFNα-2b500万U，隔El1次皮下注射；43例患者予以阿德福韦酯10mg／d，口服。当治疗无效或因不良反应不能耐受时，根据患者的意愿停药或改变治疗方案，随访24个月。评价两种药物初选治疗的疗效、不良反应、依从性及治疗成本。数据行Fisher精确概率检验。结果治疗12个月时，34例IFN初治组和43例阿德福韦酯初治组患者HBVDNA〈500拷贝／mL分别为9例和29例，各占26．5％和67．4％；ALT复常各有14例和40例，分别占41．2％和93．0％（P〈0．01）；HBeAg转阴率和HBeAg血清学转换率两组差异无统计学意义。IFN初治组中途脱落8例，占23．5％，3例患者因不良反应中断治疗，16例患者中途改变治疗药物；而阿德福韦酯初治组治疗2年间未发现与药物有关或可能有关的不良反应，患者耐受性好，中途脱落3例，占7．0％，4例患者中途改变治疗（P〈O．01）。两组患者治疗成本比较显示，IFN初治组抗病毒治疗、治疗不良反应和实验室检测的费用均高于阿德福韦酯初治组，2年人均费用增加4855元。结论对HBeAg阳性慢乙肝患者，阿德福韦酯作为初治首选药物可能是目前较经济合理的一种选择。Objective To compare the efficacy, tolerance and cost of interferon （IFN） α-2b and adefovir （ADV） in patients with chronic hepatitis B （CHB） for two years. Methods The treatment- naive outpatients with CHB were treated with IFN α-2b or ADV according to intention to treat. Among 77 patients, 34 were treated with recombinant IFN α-2b 5 MU once every other day subcutaneously （IFN group）, 43 were treated with ADV 10 mg/day orally （ADV group）. The medications were stopped or the regimens were changed due to intolerant adverse reactions or without effects according to intention to treat. The patients were followed up for 24 months. The therapeutic effects, adverse reactions, compliance and cost of two initial treatments were compared. The data were analyzed by Fisher exact probability test. Results The complete virological response （HBV DNA〈 500 copy/mL） rates after 12 months of therapy in IFN group and ADV group were 41.2 % （14/34） and 67.4% （29/43）, respectively, while the alanine aminotransferase （ALT） normalization rates were41.2% （14/34） and 93. 0% （40/43）, respectively. The rates in ADV group were both significantly greater than those in IFN group （both P〈0.01）. There were no statistically significant differences of HBeAg negative rate and HBeAg seroconversion rate between the two groups. In IFN group, the expulsion rate was 23. 5% （8/34）, the therapy was discontinued in 8. 80/00 （3/34） of patients due to adverse reactions and the medication was changed in 47. 1 % （16/34） of patients. In ADV group, there were no adverse reactions associated with medication during 2-year therapy and patients were well tolerant, the expulsion rate was 7.0% （3/43） and the regimen in 9.3% （4/43） of patients was changed （P〈0.01）. The comparison of therapeutic cost between the two groups showed that the cost of anti-viral therapy, management with adverse reactions and laboratory examinations in IFN group were all higher than those in ADV group. The averag

关 键 词：乙型肝炎 慢性 干扰素Α-2B 阿德福韦酯 费用效益分析 

分 类 号：R512.62[医药卫生—内科学]