替诺福韦酯片对乙肝病毒感染经治患者补救治疗的疗效研究

发布时间：2018-04-18 04:04

本文选题：乙肝病毒感染 + 替诺福韦酯　；参考：《中华医院感染学杂志》2017年21期

【摘要】：目的探讨替诺福韦酯片(TDF)对HBVDNA聚合酶区204位点突变的经治乙肝病毒(HBV)感染患者补救治疗的疗效及安全性。方法选取2013年1月-2014年10月医院就诊69例核苷(酸)类似物经治后出现HBVDNA聚合酶204位点突变的HBV感染患者,定期常规行实验室检测病毒转阴率、肝功能复常率、HBeAg转阴率及相关副反应,单因素和多因素分析患者病毒抑制(VR)的相关因素,根据ROC曲线确定预测因素的截断值,计算其灵敏度、特异度。结果观察疗程结束时,所有被治疗的患者耐受性良好,无一例出现严重不良反应而导致停药,96周治疗结束时,HBVDNA累积应答率为94.2%,转氨酶累积复常率92.7%,HBeAg累积转阴率为30.6%;多因素回归分析显示初始补救治疗时患者的HBVDNA载量能预测最终的抗病毒疗效(P0.001;OR,0.732;95%CI,0.625~0.879);ROC曲线分析显示其预测的截断值为:1.12×105IU/mL,其灵敏度和特异度分别为:68.4%、91.8%;肾功能、肌酐清除率、血小板及血磷检测结果在不同时间节点比较无显著差异。结论以替诺福韦酯片为基础的补救治疗对HBVDNA聚合酶区204位点突变的HBV感染经治患者安全有效,对所有抗病毒治疗的乙肝病毒感染患者,一旦发现HBVDNA水平上升,应及时进行病毒基因型耐药检测,并尽早采取补救治疗措施。
[Abstract]:Objective to investigate the efficacy and safety of tenofovir tablets in the treatment of patients with hepatitis B virus (HBV) infection with HBVDNA polymerase region 204 mutation.Methods A total of 69 patients with HBVDNA polymerase 204 mutation were selected from January 2013 to October 2014 in our hospital.The negative conversion rate of HBeAg and related side effects were analyzed by single factor and multivariate analysis. The truncation value of predictive factors was determined according to ROC curve and the sensitivity and specificity were calculated.Results at the end of the course of treatment, all patients were well tolerated.No serious adverse reactions resulted in the cumulative response rate of HBV DNA at the end of 96 weeks treatment was 94.2%, the cumulative conversion rate of aminotransferase was 92.7% and the cumulative negative rate of HBeAg was 30.6.The multivariate regression analysis showed that the HBVDNA load of patients with initial rescue therapy was 30.6%.Prediction of the final antiviral efficacy (P 0.001 / 0. 732 / 95). The ROC curve analysis showed that the predicted truncation value was 1. 12 脳 10 ~ 5 IUR / mL, and its sensitivity and specificity were: 1 / 68.4 and 91.8, respectively; renal function,There was no significant difference in creatinine clearance, platelet and blood phosphorus at different time points.Conclusion Rescue therapy based on tenofovir tablets is safe and effective for patients with HBV infection with HBVDNA polymerase region 204 mutation. Once HBVDNA level is increased in all patients with hepatitis B virus infection treated with antiviral therapy, it is safe and effective for all patients with hepatitis B virus infection treated with tenofovir tablets.Virus genotypic resistance should be detected in time and remedial measures should be taken as soon as possible.
【作者单位】：宁波市第二医院肝病科;宁波大学医学院微免教研室;
【基金】：浙江省区域专病中心建设学科基金资助项目(2014-98) 宁波市临床特色重点专科建设基金资助项目(2013-88)
【分类号】：R512.62

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