替比夫定治疗HBeAg阳性的慢性乙型肝炎104周疗效分析

发布时间：2018-03-25 07:08

本文选题：慢性乙型肝炎　切入点：替比夫定　出处：《中国感染与化疗杂志》2017年03期

【摘要】：目的观察替比夫定治疗HBeAg阳性的慢性乙型肝炎(CHB)的疗效,比较初治与序贯阿德福韦酯的疗效差异。方法将HBeAg阳性的CHB患者90例分2组,替比夫定初治组和替比夫定序贯阿德福韦酯初始疗效不佳的序贯组各45例,疗程104周。观察治疗前后肝功能、乙型肝炎病毒(HBV)标志物、HBV DNA及耐药变化。结果替比夫定疗效好,肝功能复常率、HBV DNA阴转率、HBeAg阴转率和血清转换率分别为91.1%、80.0%、57.8%和30.0%。初治组的HBV DNA转阴率高于序贯组(P0.05),但有早期应答的患者两组疗效比较差异无统计学意义(P0.05)。两组有早期应答患者各项疗效指标均显著好于无早期应答患者,而且发生病毒学突破也明显减少,两者比较差异有非常显著的统计学意义(P0.000 1~0.05)。结论替比夫定治疗CHB疗效肯定,初治疗效好于序贯阿德福韦酯疗效不佳患者,但后者有早期应答反应时其治疗104周的各项疗效指标与初治组差异无统计学意义(P0.05),因此,替比夫定序贯治疗时应严密观察早期抗病毒应答反应,及时进行优化治疗。
[Abstract]:Objective to observe the efficacy of tibivudine in the treatment of chronic hepatitis B (HBeAg) positive patients, and to compare the curative effect between primary and sequential adefovir dipivoxil. Methods 90 patients with HBeAg positive CHB were divided into two groups. There were 45 cases in the initial treatment group and 45 cases in the tibivudine sequential adefovir group, with a course of 104 weeks. The liver function, hepatitis B virus (HBV) markers and the changes of HBV DNA and drug resistance were observed before and after the treatment. Results tibivudine was effective, and the effect of tibivudine was better than that of tibivudine. The negative conversion rate of HBV-HBV-HBeAg and seroconversion rate were 91.1% and 30.0%, respectively. The negative conversion rate of HBV DNA in the first treatment group was higher than that in the sequential group, but there was no significant difference between the two groups in the curative effect of the two groups. All the therapeutic indexes of the patients with stage 1 response were significantly better than those of the patients without early response. The number of virological breakthroughs was also significantly reduced, and there was a significant difference between the two groups (P 0.000 10.05). Conclusion tibivudine is more effective than sequential adefovir in the treatment of CHB. However, there was no significant difference between the treatment group and the initial treatment group when the latter had early response (P 0.05). Therefore, tibiff sequential therapy should closely observe the early antiviral response and optimize the treatment in time.
【作者单位】：广东医学院附属医院感染内科;
【分类号】：R512.62

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