替诺福韦酯单用治疗慢性乙型肝炎的临床疗效研究

发布时间：2018-02-01 08:21

本文关键词： 乙型肝炎慢性替诺福韦酯恩替卡韦治疗结果　出处：《中国全科医学》2015年34期 　论文类型：期刊论文

【摘要】：目的探讨替诺福韦酯(TDF)单用治疗慢性乙型肝炎(CHB)的临床疗效。方法选取2012年2月—2014年9月到广州医科大学附属第二医院进行治疗的CHB患者83例。两组患者自就诊时均单独服用TDF,根据患者24周后的治疗方案,以改服恩替卡韦(ETV)的患者为对照组(n=43),以持续服用TDF的患者为观察组(n=40),观察周期均为48周。记录并比较两组治疗前及治疗后4、12、24、36、48周的HBV DNA水平、HBV DNA不可检测率、血清ALT水平、乙型肝炎e抗原(HBe Ag)血清学应答情况及不良反应。结果 (1)两组性别、平均年龄及平均病程比较,差异无统计学意义(P0.05)。(2)两组不同时间点HBV DNA水平比较,差异有统计学意义(P0.05)。其中组间比较,差异有统计学意义(F组别=77.11,P0.05);不同时间比较,差异有统计学意义(F时间=50.11,P0.05);二者存在交互作用,差异有统计学意义(F交互=61.12,P0.05)。(3)治疗后24、36、48周,两组HBV DNA不可检测率比较,差异均无统计学意义(P0.05)。生存分析显示,两组HBV DNA不可检测率比较,差异无统计学意义(log Rank检验χ2=0.01,P0.05)。(4)两组不同时间点ALT水平比较,差异有统计学意义(P0.05)。其中组间比较,差异无统计学意义(F组别=33.16,P0.05);不同时间比较,差异无统计学意义(F时间=39.88,P0.05);二者存在交互作用,差异有统计学意义(F交互=43.19,P0.05)。治疗后36、48周,两组ALT复常率比较,差异无统计学意义(P0.05)。(5)治疗后48周,两组血清HBe Ag转阴率和转换率比较,差异均无统计学意义(P0.05)。(6)治疗期间,两组均无严重不良反应发生。结论 TDF单用治疗CHB的临床疗效较确切,抗HBV作用较好,可持续改善患者肝功能,且不良反应较少,建议推广使用。
[Abstract]:Objective to investigate the efficacy of tenofovir ester TDF1 in the treatment of chronic hepatitis B (CHB). Methods from February 2012 to September 2014, 83 patients with CHB were treated in the second affiliated Hospital of Guangzhou Medical University. The two groups were treated with TDF alone. According to the treatment plan of patients after 24 weeks, the patients who were treated with entecavir (ETV) as control group, and those who took TDF continuously as observation group (n = 40). The observation period was 48 weeks. The levels of HBV DNA before and after treatment were recorded and compared. The undetectable rate of HBV DNA and the level of serum ALT were compared between the two groups. The serological responses and adverse reactions of HBe Ag1) were compared between the two groups in terms of sex, average age and course of disease. There was no significant difference in the level of HBV DNA between the two groups at different time points, and the difference was statistically significant (P 0.05). The difference was statistically significant in group F (77.11) (P0.05); The difference was statistically significant at different time points (50.11) and P0.05 (P < 0.05). There was interaction between the two groups, and the difference was statistically significant. The undetectable rate of HBV DNA was compared between the two groups at 24 ~ 36 ~ 48 weeks after treatment. The survival analysis showed that the undetectable rate of HBV DNA in the two groups was not statistically significant compared with that in the control group (蠂 ~ 20.01). The difference of ALT level between the two groups at different time points was statistically significant (P 0.05). There was no significant difference between the two groups in group F and group F (P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%). P0.05; There was no significant difference between different time groups (P 0.05). There was interaction between the two groups, and the difference was statistically significant (P 0.05). After 36 weeks of treatment, the recovery rate of ALT was compared between the two groups. There was no significant difference in serum HBe Ag conversion rate between the two groups 48 weeks after treatment. There was no significant difference between the two groups during the treatment period. Conclusion the clinical efficacy of TDF alone in the treatment of CHB is more accurate, and the anti-#en2# effect is better. Sustainable improvement of liver function, and less adverse reactions, recommended to promote use.
【作者单位】：广州医科大学附属第二医院药学部;广州医科大学附属第二医院感染科;广州医药有限公司;
【分类号】：R512.62
【正文快照】： 慢性乙型肝炎(CHB)是感染乙型肝炎病毒(HBV)引起的传染性疾病[1],由于HBV复制过程中的变异率较高,故CHB在长期药物压力下容易产生耐药性。《慢性乙型肝炎防治指南(2010年版)》[2]指出,目前治疗CHB常用的拉米夫定、阿德福韦酯、替比夫定均存在不同程度耐药,因此探索新型抗HBV药

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