摘要
目的评价恩替卡韦(ETV)治疗不同类型慢性乙型肝炎患者的疗效。方法 47例慢性乙型肝炎患者分别根据血清HBeAg、拉米夫定治疗经历、疾病进展程度、丙氨酸氨基转移酶(ALT)水平不同,分为HBeAg阳性组与HBeAg阴性组,核苷初治组与拉米夫定耐药组,肝硬化组与慢性乙型肝炎组,ALT≤2×正常值上限(ULN)组、2×ULN<ALT≤5×ULN组及ALT>5×ULN组,给予ETV0.5mg或1.0mg,1次/d口服(0.5mg:核苷初治组;1.0mg:拉米夫定耐药组)。观察指标:基线及治疗12、24、36、48周血清HBVDNA水平、HBV血清学标志物及肝功能变化。结果 ETV治疗12、24、36、48周HBVDNA阴转率分别为44.68%、53.19%、55.32%、68.09%,ALT复常率为65.96%、82.98%、91.49%、93.62%,24、48周HBeAg阳性患者HBeAg血清学转换率为13.51%、14.89%。在分层评价中,ETV治疗核苷初治组、拉米夫定耐药组HBVDNA阴转率差异有统计学意义,12、24、36、48周分别为56.67%、23.53%(P<0.05),70%、23.53%(P<0.01),73.33%、23.53%(P<0.01),83.33%、41.18%(P<0.01)。而HBeAg阳性、HBeAg阴性组,肝硬化、慢性乙型肝炎组,不同ALT水平组组间病毒学应答率差异无统计学意义。结论 ETV治疗慢性乙型肝炎患者可获得强效的抗病毒活性。核苷初治患者应用ETV治疗的效果明显优于拉米夫定耐药患者。ETV治疗HBeAg阳性、HBeAg阴性患者,肝硬化、慢性乙型肝炎患者,不同ALT水平患者,抗病毒疗效相似。
Objective To evaluate effect of entecavir（ETV）on different types of chronic hepatitis B（CHB）.Methods Forty-seven cases of CHB were selected randomly.According to HBeAg condition,treatment history with lamivudine（LVD）,progress of disease,levels of alanine aminotransferase（ALT）,they were respectively divided into the HBeAg-positive group and the HBeAg-negative group,the nucleoside-analogue naive group and the LVD-refractory group,the liver cirrhosis group and the chronic hepatitis B group,the group of ALT below 2 times upper limit normalization（ULN）,the group of ALT between 2 and 5 times ULN,and the group of ALT exceed 5 times ULN.They were treated with daily dose of ETV 0.5 and 1.0 mg（0.5mg for nucleoside-naive group,1.0 mg for LVD-refractory group）.Evaluation indexes：serum HBVDNA,HBV serological markers,and liver function tests at baselin,week-12,week-24,week-36 and week-48 with ETV therapy.Results At week-12,week-24,week-36 and week-48 with ETV therapy,the ratios of cases with undetectable HBVDNA were 44.68%,53.19%,55.32% and 68.09% respectively,that with ALT normalization were 65.96%,82.98%,91.49% and 93.62% respectively.The ratios of HBe seroconversion were 13.51% and 14.89% in HBeAg-positive cases at week-24 and week-48 with ETV therapy.The ratios of cases with undetectable serum HBV DNA at week-12,week-24,week-36 and week-48 in nucleoside-analogue naive group were 56.67%,70%,73.33% and 83.33% respectively,which were superior to that in LVD-refractory group（23.53%,23.53%,23.53% and 41.18%）.There was no significant difference of virological response between HBeAg-positive group with HBeAg-negative group,or between liver cirrhosis group with chronic hepatitis B group,neither among the groups of different ALT levels.Conclusion ETV can suppress HBVDNA rapidly for chronic hepatitis B patients.The effect of nucleoside-analogue naive group with ETV therapy was superior to that of LVD-refractory group.The effect of ETV therapy has no significant difference between HBeAg-positive group with HBeAg-negative group,or between liver cirrhosis group with chronic hepatitis B group,neither among the groups of different ALT levels.
出处
《实用药物与临床》
CAS
2010年第3期167-171,共5页
Practical Pharmacy and Clinical Remedies
基金
辽宁省自然科学基金项目(20072114)
