NAs治疗HBeAg阳性的慢乙肝从3年到5年提高联合应答是有限的：real life队列研究

发布时间：2018-03-20 19:14

  本文选题：慢性乙型病毒性肝炎　切入点：联合应答　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在评估HBeAg阳性的慢乙肝患者经核苷类似物治疗后发生联合应答(包括HBVDNA转阴、ALT复常和HBeAg血清学转换)的情况,并且了解延长治疗时间对于提高联合应答率是否有效。方法:总共有280例从2004年8月至2014年2月在重庆医科大学第二附属医院感染科随访治疗HBeAg阳性的慢性乙型病毒性肝炎患者进入研究,190例经恩替卡韦单药治疗,90例经替比夫定单药治疗。收集所有患者基线人口学特征、临床及实验室检查资料,根据患者基线HBVDNA和ALT的水平,将280例患者分为优势人群和非优势人群组,使用SSPSS22.0软件进行数据统计分析。结果:Kaplan-Meier统计分析显示,在总人群中第1年累积联合应答率是8.6%,第2年是13.2%,第3年是19.1%,第4年是24.2%,第5年是26.0%。在优势人群中,前3年的联合应答率明显高于非优势人群(P=0.043),3年之后两组人群联合应答率无差异。并且在优势人群中联合应答主要发生在前3年。多因素cox回归分析表明在优势人群中第1年发生HBeAg血清学转换是发生联合应答唯一相关因素(Hazard ratio[HR],16.321;P=0.000)。经过3年的核苷类似物治疗,基线APRI评分≤0.5患者的比例到第三年从15.6%增加至71.3%,基线APRI评分1.5患者的比例到第三年从43.8%下降至1.9%。结论:核苷类似物治疗HBeAg阳性的慢性乙型肝炎患者从3到5年提高联合应答率是有限的,尤其针对优势人群。因此寻求新的转换治疗方案是必要的。
[Abstract]:Objective: to evaluate the combined response of HBeAg positive patients with chronic hepatitis B after treatment with nucleoside analogues (including the return of HBVDNA to negative alt and HBeAg serological conversion). Methods: from August 2004 to February 2014, a total of 280 patients with HBeAg positive chronic type B were followed up from August 2004 to February 2014 in the second affiliated Hospital infection Department of Chongqing Medical University. Patients with viral hepatitis entered the study of 190 patients treated with entecavir alone and 90 patients received tibiff order. Baseline demographic characteristics of all patients were collected. According to the level of HBVDNA and ALT, 280 patients were divided into dominant group and non-dominant group. The data were analyzed by SSPSS22.0 software. The cumulative joint response rate was 8.6 in the first year of the total population, 13.2in the second year, 19.1in the third year, 24.2in the fourth year, 26.0in the fifth year. The combined response rate in the first 3 years was significantly higher than that in the non-dominant population, but there was no difference between the two groups after 3 years. The combined response occurred mainly in the first 3 years in the dominant population. Multivariate cox regression analysis showed that the co-response rate was higher in the dominant population. The occurrence of HBeAg serological transformation in the first year of the group is the only relevant factor for the occurrence of joint response. Hazard ratio [HR] 16.321P0. 000. After 3 years of nucleoside analogue therapy, The proportion of patients with baseline APRI score 鈮，

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