恩替卡韦在B、C基因型乙肝患者间临床疗效差异性研究

发布时间：2018-05-20 03:36

本文选题：恩替卡韦 + 慢性乙型肝炎　；参考：《石河子大学》2017年硕士论文

【摘要】：背景:恩替卡韦对HBV抗病毒治疗疗效的研究是核苷类似物抗病毒治疗的重要内容,临床上已经注意到恩替卡韦对慢性乙型病毒性肝炎(CHB)不同临床时期的抗病毒治疗疗效差异,而B、C基因型的CHB不同临床时期是否影响恩替卡韦对CHB的抗病毒疗效,目前报道较少,明确恩替卡韦对B、C基因型CHB患者之间的临床疗效差异,指导恩替卡韦对B、C基因型乙肝患者的临床用药,争取最大限度的长期抑制HBV复制,减轻肝细胞炎症坏死,从而改善患者的生活质量并延长其生存时间。特别是在其他药物抗病毒疗效欠佳、耐药率高且患者依从性差的情况下,通过恩替卡韦对B、C基因型CHB患者之间的临床疗效差异性观察,对促进临床乙肝病毒治疗提供理论支持具有重要意义。目的:分析恩替卡韦对B、C基因型CHB患者之间的抗病毒治疗疗效并比较差异性。方法:对我院符合标准的初始抗病毒治疗的慢性乙型病毒性肝炎肝炎期、肝硬化代偿期及肝硬化失代偿期患者住院资料进行回顾性分析。根据纳入标准及排除标准纳入,分别观察CHB患者在经恩替卡韦治疗4、12、24及48周时,HBVDNA载量、HBsAg定量、TBIL定量、ALB定量及ALT水平。治疗结束后观察HBeAg血清学转换情况及肝硬化失代偿期中腹水,消化道出血及肝性脑病的再发情况。结果:共纳入初始抗病毒治疗的B基因型CHB患者60例、C基因型CHB患者100例,(1)性别分布,男性119人,占病例总数的74.37%(119/160),女性41人,占病例总数的25.63%(41/160)。男女比例2.9:1,男性感染HBV的几率明显高于女性2倍以上。(2)年龄分布,30-50岁的患者比例最高,占病例总数的63.75%(102/160)。(3)CHB患者治疗基线时水平:160例B、C基因型CHB患者治疗前HBVDNA载量、HBsAg定量及ALT水平比较差异无统计学意义(P0.05)。但肝炎期、肝硬化代偿期与肝硬化失代偿期患者相比,血清总胆红素(TBIL)、血清白蛋白水平(ALB)差异有统计学意义(P0.05)。(4)160例CHB患者治疗后HBVDNA载量及ALT水平较基线时均有明显下降,治疗结束时HBVDNA阴转率81.25%,ALT复常率78.75%,但B、C基因型两组患者HBVDNA载量变化及ALT复常率差异无统计学意义。(5)肝炎期及肝硬化代偿期与肝硬化失代偿期患者相比,在治疗4、12、24及48周时,HBVDNA阴转率及ALT阴转率差异均具有统计学意义(P0.05),HBsAg阴转率无统计学差异(P0.05)。(6)B基因型CHB患者肝硬化失代偿期经恩替卡韦治疗48周后疗效显著,至治疗结束时,肝硬化失代偿期并腹水患者、肝硬化失代偿期并出血患者及肝硬化失代偿期并肝性脑病患者均较基线时好转,差异具有统计学意义(P0.05),同样,C基因型CHB患者肝硬化失代偿期经恩替卡韦治疗48周后疗效与基线时相比也得到相似结果,但相同时期的B、C两基因型患者之间相比,无统计学差异(P0.05)。(7)相同时期的B、C基因型之间相比,HBVDNA阴转率、ALT阴转率ALB复常率、TBIL复常率及HBsAg阴转率均无统计学差异(P0.05)。结论:1.恩替卡韦抗病毒治疗疗效与B、C基因型无关。
[Abstract]:Background: entecavir's antiviral treatment for HBV is an important part of the antiviral therapy of nucleoside analogues. It has been noted that entecavir has different therapeutic effects on the antiviral treatment of chronic hepatitis B (CHB) in different clinical periods, and whether B, C genotype CHB affects the resistance of entecavir to CHB The efficacy of the virus is less reported. The clinical effect of entecavir on B and C genotype CHB patients is clearly defined. It guides the clinical use of entecavir for B and C genotype hepatitis B patients, strives for the maximum long-term inhibition of HBV replication and alleviating inflammatory necrosis of the liver cells, improving the quality of life and prolonging the survival time of the patients. It is of great significance to provide theoretical support for the promotion of clinical hepatitis B virus therapy through the observation of the clinical efficacy of entecavir on B and C genotype CHB in the case of poor antiviral effect, high drug resistance and poor compliance. Methods: a retrospective analysis was made to the data of patients with chronic hepatitis B, liver cirrhosis and decompensated cirrhosis in our hospital, which accords with the standard initial antiviral treatment. According to the inclusion criteria and exclusion criteria, the patients with CHB were treated with entecavir to treat 4,12,2 respectively. 4 and 48 weeks, HBVDNA load, HBsAg quantitative, TBIL quantitative, ALB quantitative and ALT level. After the treatment, the serological conversion of HBeAg and the recurrence of ascites, digestive tract hemorrhage and hepatic encephalopathy were observed. Results: 60 cases of B based CHB patients were included in the initial antiviral treatment, 100 cases of C genotype CHB patients, and (1) sex. The distribution, 119 men, accounted for 74.37% (119/160) of the total cases, 41 women, 25.63% (41/160) of the total cases. The ratio of men and women was 2.9:1, the rate of male infection of HBV was significantly higher than that of women. (2) age distribution, the proportion of 30-50 year old patients was the highest, accounting for 63.75% (102/160). (3) CHB patients at the baseline level: 160 B, C gene. There was no significant difference in the HBVDNA load, HBsAg quantitative and ALT levels before treatment for patients with CHB (P0.05). However, the serum total bilirubin (TBIL) and serum albumin level (ALB) were statistically significant (P0.05) compared with the patients with decompensated cirrhosis (P0.05). (4) the HBVDNA load and ALT level after treatment in 160 cases of CHB patients. The HBVDNA negative rate was 81.25% and the ALT recurrence rate was 78.75% at the end of the treatment, but there was no significant difference in the HBVDNA load and the ALT recurrence rate in the two groups of B and C genotypes. (5) the rate of HBVDNA negative and ALT negative in the 4,12,24 and 48 weeks after the treatment of liver cirrhosis and the decompensation period of liver cirrhosis. The difference in rate of rate was statistically significant (P0.05), and there was no statistical difference in the negative rate of HBsAg (P0.05). (6) the effect of the decompensation period of the B genotype CHB patients was significant after 48 weeks of entecavir treatment, and at the end of the treatment, the decompensated cirrhosis and ascites, the decompensated cirrhosis and the liver cirrhosis and hepatic encephalopathy at the end of the treatment. The patients were all better than the baseline (P0.05). Similarly, the curative effect of C genotype CHB patients after 48 weeks of entecavir treatment was similar to that of baseline, but there was no statistical difference between B and C two genotypes at the same time (P0.05). (7) the B, C genotypes at the same time. Compared with HBVDNA negative conversion rate, ALT negative rate ALB repetition rate, TBIL repetition rate and HBsAg negative rate, there was no statistical difference (P0.05). Conclusion: 1. the antiviral effect of entecavir is not related to B, C genotype.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

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