慢性乙型肝炎不规范停用恩替卡韦复发后再次恩替卡韦治疗的效果

发布时间：2018-06-03 23:49

本文选题：慢性乙型肝炎 + 恩替卡韦　；参考：《广东医学》2015年08期

【摘要】：目的探讨慢性乙型肝炎(乙肝)不规范停用恩替卡韦复发后再次使用恩替卡韦抗病毒治疗的疗效。方法 30例不规范停用恩替卡韦治疗后复发的肝炎患者(重度25例,重型5例;复治组)与同期住院的80例乙肝初发患者(重度65例,重型15例;初治组)均服用恩替卡韦抗病毒治疗。观察两组治疗后第4、12、48周的疗效,主要的疗效观察指标为生化学复常率、HBV-DNA转阴率、HBe Ag血清学转换率,次要的疗效观察指标为耐药性。结果所有患者均未发现病毒学突破,且未检测到耐药菌株。复治组生化学复常率于3个时间段内整体水平均低于初治组,其中第4周内差异有统计学意义(P0.05),第12周及48周内差异无统计学意义(P0.05);复治组HBV-DNA阴转率均高于初治组,其中第4、12周差异有统计学意义(P0.05);复治组重型肝炎患者病死率显著高于初治组,差异有统计学意义(P0.05);复治组第48周HBe Ag阳性患者血清学转换率及HBs Ag滴度下降50%比例均高于初治组,前者差异有统计学意义(P0.05),后者差异无统计学意义(P0.05)。结论慢性乙肝不规范停药复发者与初治者相比,肝功能恢复慢,重型肝炎死亡率高;停用恩替卡韦复发者复治仍使用恩替卡韦抗病毒的疗效及安全性良好。
[Abstract]:Objective to evaluate the efficacy of repeated use of entecavir in the treatment of chronic hepatitis B (CHB) after non-standard cessation of entecavir. Methods Thirty patients with recurrent hepatitis (25 severe, 5 severe, retreated) and 80 primary hepatitis B patients (65 severe and 15 severe) were enrolled in the same period. All patients were treated with entecavir antiviral therapy. The therapeutic effect of the two groups was observed at the 44th week after treatment. The main therapeutic indexes were biochemical normality rate and HBV-DNA negative conversion rate and HBe Ag serological conversion rate, and the secondary therapeutic observation index was drug resistance. Results no virological breakthrough was found in all patients, and no resistant strains were detected. The overall level of biochemical normalizing rate in the treatment group was lower than that in the initial treatment group in three time periods, and the difference in the fourth week was statistically significant (P 0.05), but there was no significant difference in the 12th week and the 48th week, the negative conversion rate of HBV-DNA in the treatment group was higher than that in the initial treatment group, the negative conversion rate of HBV-DNA in the treatment group was higher than that in the initial treatment group. In the 4th week, the difference was statistically significant (P 0.05), the fatality rate of the patients with severe hepatitis was significantly higher than that of the initial treatment group, the mortality of the patients with severe hepatitis was significantly higher than that of the control group. The serological conversion rate and the decrease of HBs Ag titer in the patients with HBe Ag positive were 50% higher than those in the first treatment group at the 48th week. The former had statistical significance (P 0.05), but the latter had no significant difference (P 0.05). Conclusion the recovery of liver function is slower and the mortality rate of severe hepatitis is higher in patients with nonstandard withdrawal of chronic hepatitis B than in the first treatment, and the efficacy and safety of using entecavir in patients with recurrent chronic hepatitis B are good.
【作者单位】：南昌大学第一附属医院感染科;
【基金】：江西省教育厅青年科学基金立项项目(编号:GJJ14175) 江西省研究生创新专项资金立项项目(编号:YC2013-S011)
【分类号】：R512.62

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