替比夫定优化治疗HBeAg阳性慢性乙型肝炎的疗效及安全性观察  

The safety and efficacy of Telbivudine optimization treatment on patients with HBeAg positive chronic hepatitis B

作　　者：范平[1] 陈仕祥[1] 周艳[1] 何维新[1] 熊志远[1] 江军[1] 

机构地区：[1]解放军第113医院肝病科,宁波315040

出　　处：《中华消化病与影像杂志（电子版）》2011年第1期25-28,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的观察替比夫定(LDT)优化治疗对HBeAg阳性慢性乙型肝炎患者的疗效及安全性。方法选择基线HBV DNA<109copies/ml、ALT>2 ULN的45例HBeAg阳性慢性乙型肝炎患者,给予LDT600 mg/d治疗。4、12、24、52周时分别检测HBV DNA、HBeAg和肝功能。24周时HBV DNA≥500 copies/ml者,加阿德福韦酯10 mg/d联合;HBV DNA<500 copies/ml者,继续单服替比夫定。结果 45例中44例治疗52周以上,4、12、24、52周时HBV DNA检测率分别0、17.8%、66.7%和82.2%;ALT复常率分别为17.8%、57.8%、77.8%和95.6%;HBeAg血清转阴率分别为0、13.3%、28.9%和57.8%。另外1例因严重不良反应而换用恩替卡韦治疗。总耐药率及严重不良反应率分别为4.44%和2.22%。结论临床应用LDT治疗HBeAg阳性慢性乙肝患者,通过基线的筛选及在治疗24周时根据HBV DNA水平,联合阿德福韦酯优化治疗,则52周能取得较好的疗效及安全性。Objective To observe the safety and efficacy of Telbivudine optimization treatment on patients with HBeAg positive chronic hepatitis B. Methods Forty-five chronic hepatitis B patients with the baseline on HBV DNA quantitation less than 9 log10copies/ml, ALT levels greater than 2 times of the normal levels and HBeAg positive were chosen and treated with Telbivudine at the dose of 600mg/d. In 4, 12, 24 and 52 weeks, HBV DNA quantitation, serum HBeAg and liver function test were performed. If HBV DNA quantitation was more than 500 copies/ml in 24 weeks, these patients were added Adefovir at the dose of 10 mg/d combined with Telbivudine therapy; but if HBV DNA quantitation was less than 500 copies/ml in 24 weeks, Telbivudine therapy alone was continued. Results In 45 cases, 44 cases accepted antiviral treatment over 52 weeks. In 4, 12, 24 and 52 weeks, the HBV DNA undetection rate was 0%, 17.8% , 55.6% and 82.2%, respectively; the rate of ALT back to normal was 17.8%, 57.8%, 77.8% and 95.6%, re- spectively; serum HBeAg negative conversion rate was 0%, 13.3%, 28.9% and 57.8%, respectively. In ad- dition, because of serious adverse response, the other 1 case was changed into Entecavir treatment. The in- cidence for total resistance and serious adverse response was 4.44% and 2.22%, respectively. Conclusion When patients with HBeAg-positive chronic hepatitis B were treated with Telbivudine, better efficacy and safety could be expected from the Telbivudine optimization therapy including the baseline screening and addition of Adefovir dependent on the levels of HBV DNA quantitation at 24 weeks.

关 键 词：替比夫定 HBEAG阳性 慢性乙型肝炎 疗效及安全性 

分 类 号：R512.62[医药卫生—内科学]