替诺福韦酯序贯治疗应答不佳HBeAg(+)慢性乙肝患者疗效分析  

The effect of patients with chronic hepatitis B HBeAg(+) with poor response to treatment by converting to sequential treatment with tenofovir dipivoxil

作　　者：廖志雄 罗亚辉[2] 程良斌[3] LIAO Zhi-xiong;LUO Ya-hui;CHENG Liang-bin(Hanchuan Traditional Chinese Medicine Hospital of Hubei Province, Xiaogan Hubei 431600 China;Hanchuan People's Hospital, Hubei Province,Xiaogan Hubei 431600 China;Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei 430061 China)

机构地区：[1]湖北省汉川市中医医院内科,湖北孝感431600 [2]湖北省汉川市人民医院儿科,湖北孝感431600 [3]湖北省中医院肝病科,湖北武汉430061

出　　处：《海南医学院学报》2020年第6期444-448,共5页Journal of Hainan Medical University

基　　金：武汉市科技局(2015061701011646)~~

摘　　要：目的:探究慢性乙肝HBeAg(+)患者治疗应答不佳转用替诺福韦酯序贯治疗的疗效,为临床更好的治疗慢性乙肝HBeAg(+)患者提供理论依据。方法:选取本院收治的90例慢性乙肝HBeAg(+)患者作为研究对象,随机分成延用富马酸替诺福韦二吡呋酯片治疗的延用组和转用替诺福韦酯序贯治疗的转用组各45例。比较两组治疗前后HBeAg和HBV-DNA含量、肝功能指标(TBIL、TC、INR比值)、血清学应答和生化学应答情况及不良反应(胃肠道症状、恶心/乏力、皮疹)发生情况。结果:延用/转用12个月比较,转用组HBeAg、HBV-DNA低于延用组,差异均有统计学意义(P<0.05)。延用/转用12个月比较,转用组TBIL含量高于延用组、转用组INR比值低于延用组,差异均有统计学意义(P<0.05)。延用/转用12月进行组间比较,转用组HBeAg血清转换率高于延用组,转用组HBeAg、ALT复常率高于延用组,差异均有统计学意义(P<0.05)。延用组不良反应发生率高于转用组,差异有统计学意义(P<0.05)。结论:针对慢性乙肝HBeAg(+)患者治疗应答不佳转用替诺福韦酯序贯治疗,不仅可以提高治疗效果,而且可以有效减少不良反应的发生情况。Objective :To explore the therapeutic effect of patients with chronic hepatitis B HBeAg(+)with poor treatment response to tenofovir ester sequential treatment,to provide a theoretical basis for better clinical treatment of chronic hepatitis B HBeAg(+)patients.Methods:Totally 90 patients with chronic hepatitis B HBeAg(+)who were treated in our hospital from December 2016 to December 2018 were selected and randomly divided into 2 groups the extended group treated with Verard and the sequential transfected tenofovir dipivoxil with 45 cases in each group.The levels of HBeAg and HBV-DNA,indexes of liver function(TBIL,TC,INR),serological and biochemical responses and adverse reactions(gastrointestinal symptoms,nausea/fatigue,rash)before and after treatment were compared between the two groups,and their statistical differences were analysed.Results:After 12 months of extension/conversion,HBeAg and HBV-DNA in the conversion group were lower than those in the extension group and hbv-dna with statistically significant differences(P<0.05).The TBIL INR in the treatment group was higher than that in the treatment group,with statistically significant differences(P<0.05).The HBeAg serum conversion rate in the treatment group was higher than that in the treatment group,and the ALT recurrence rate in the treatment group was higher than that in the treatment group,with statistically significant differences(P<0.05).The incidence of adverse reactions in the prolonged use group was higher than that in the switched use group,and the difference was statistically significant(P<0.05).Conclusions:For patients with chronic hepatitis B HBeAg(+)with poor treatment response,the sequential treatment with tenofovir ester can not only improve the treatment effect,but also effectively reduce the occurrence of adverse reactions.

关 键 词：慢性乙肝 HBEAG(+) 应答不佳 替诺福韦 

分 类 号：R512.62[医药卫生—内科学]