ETV或LAM加ADV治疗HBeAg阳性慢性乙肝的回顾性分析  

Retrospective analysis of entecavir or lamivudine plus adefovir combination therapy in chronic HBeAg-positive hepatitis B

作　　者：袁勇[1] 林丹[1] YUAN Yong LIN Dan(Department of Liver Disease of Traditional Chinese Medicine, Hainan Medical College Affiliated Hospital, Haikou, Hainan 570102, China)

机构地区：[1]海南医学院附属医院中医肝病专科,海南海口570102

出　　处：《中国热带医学》2017年第1期101-103,共3页China Tropical Medicine

摘　　要：目的通过对恩替卡韦(entecavir,ETV)分散片单药治疗,与拉米夫定(lamivudine,LAM)加用阿德福韦酯(adefovir,ADV)挽救治疗HBe Ag阳性慢性乙型肝炎(chronic hepatitis B,CHB)患者的回顾性分析,比较两种方案的疗效。方法选取2008年1月—2016年1月的158例HBe Ag阳性CHB患者,其中使用单药ETV分散片治疗4年以上的患者80例为A组,初始使用LAM并产生耐药,而加用ADV治疗4年以上患者78例为B组。比较两组治疗24周(T1)、48周(T2)、96周(T3)、144周(T4)、192周(T5)5个时段内HBV-DNA转阴率、HBe Ag血清转换率、丙氨酸转氨酶(alanine aminotransferase,ALT)复常率等指标,分析病毒学突破及病毒耐药发生差异。结果两组患者HBV-DNA转阴率在T1~T5时段内,差异均无统计学意义(P>0.05);各组内比较,T2~T5各时段均较T1提升,差异均有统计学意义(P<0.05)。两组患者ALT复常率在T1~T3各时段内比较差异均无统计学意义(P>0.05),T4~T5时段内差异均有统计学意义(P<0.05)。A组HBe Ag血清转换率各时段均高于B组,差异有统计学意义(P<0.05)。T2~T5时段,两组ALT复常率及HBe Ag血清转换率自身前后比较,均较T1时提升,差异均有统计学意义(P<0.05)。同时,治疗过程中A组未见病毒学突破及病毒耐药发生,B组累计发生病毒学突破2例(2.6%)。结论 ETV分散片持续长期抑制乙肝病毒复制,减轻肝细胞炎性坏死,促进HBe Ag血清学转换能力较强,优于LAM加用ADV挽救治疗组。Objective A retrospective analysis of entecavir（ETV） dispersive monotherapy and lamivudine（LAM） plus adefovir（ADV） in the treatment of HBe Ag-positive chronic hepatitis B was performed, and the efficacy of the two treatment was compared. Methods We selected 158 patients with HBe Ag- positive chronic hepatitis B（CHB） from January 2008 to January 2016, which 80 cases were treated with single-drug ETV dispersible tablets for more than 4 years in group A, and 78 cases with initial use of LAM and resistance, and ADV plus treatment for more than 4 years in group B. HBV-DNA negative conversion rate, HBe Ag seroconversion rate, ALT normalization rate, and the change of virological breakthrough and viral resistance were analyzed in two groups of treatment for 24 weeks（T1）, 48 weeks（T2）, 96 weeks（T3）, 144 weeks（T4）, and 192weeks（T5）. Results There was no significant difference in the rate of HBV-DNA negative conversion in T1- T5 periods（P〉0.05）.Within each group to compare, T2- T5 were increased than T1, there was significant difference（P〈0.05）. There was no significant difference in ALT normalization rate in T1- T3 in the two groups（P〉0.05）, and there was significant difference in T4- T5（P〈0.05）. The seroconversion rate of HBe Ag in group A was higher than that in group B at each time point, the difference was statistically significant（P〈0.05）. The ALT normalization rate and the HBe Ag seroconversion rate in T2- T5 were significantly higher than those in T1（P〈0.05）. At the same time, there was no virological breakthrough and viral resistance in group A, and 2 cases（2.6%） had viral breakthrough in group B. Conclusion ETV dispersible tablets can inhibit hepatitis B virus replication for long-term, reduce hepatocyte inflammatory necrosis and promote HBe Ag seroconversion strong,better than LAM plus ADV rescue treatment group.

关 键 词：恩替卡韦 拉米夫定 阿德福韦酯 HBEAG阳性 慢性乙型肝炎 

分 类 号：R512.62[医药卫生—内科学]