恩替卡韦治疗HBeAg阳性慢性重度乙型肝炎临床疗效

Efficacy of Entecavir for patients of chronic severe-degree hepatitis B with HBeAg-positive

目的评估恩替卡韦治疗HBeAg阳性慢性重度乙型肝炎临床疗效。方法将HBeAg阳性慢性重度乙型肝炎患者58例随机分为治疗组29例和对照组29例,治疗组用恩替卡韦0.5 mg/天治疗,疗程为48周,前4周加用保肝药物治疗。对照组患者保肝治疗,疗程为48周。结果治疗组ALT复常率(93.1%)、HBeAg阴转率(44.8%)、HBeAg/抗HBe转换率(41.4%)、HBV DNA阴转率93.1%均显著高于对照组(P值<0.05),且治疗组肝组织病理炎症活动度好转率(93.1%)和纤维化好转率(72.4%)也显著高于对照组(P值<0.05),对照组有13.8%发生重型肝炎和13.8%发生肝硬化,而治疗组无病人发生重型肝炎和肝硬化(P值<0.05)。结论恩替卡韦对HBeAg阳性慢性重度乙型肝炎有较好的临床疗效,能阻止重型肝炎和肝硬化的发生。

Objective To evaluate the effects of Entecavir for patients of chronic severe-degree hepatitis B with HBeAg-positive.Methods 58 patients with chronic severe-degree hepatitis B were randomly divided into two groups（treatment group and control group）.29 patients in the treatment group were treated with Entecavir 0.5mg/d for 48 weeks and protect-liver drug for the first 4 weeks.29 patients in control group were treated with protect-liver drug for 48 weeks.Results After therapy for 48 weeks,ALT normalization-rate,the negative-rate of serum HBV DNA and HBeAg,the transition-rate of serum HBeAg/ Anti-Hbe in the treated group were all significantly higher than that of the control group（93.1%vs59.3%,93.1%vs11.1%,44.8%vs11.1%,41.4%vs 11.1%,respectively.χ2-value were 8.98,37.79,7.79,6.53.P〈0.005,〈0.001,〈0.01,〈0.05,respectively）.The improve-rate of hepatic histological activityand hepatic fibrosis in needle liver biopsy specimens in the treatment group were all significantly higher thanthat in the control group（93.1%vs44.4%,72.4%vs33.3%,respectively.χ2-value were 15.66,8.58,P〈0.001,〈0.005,respectively）.Conclusion The clinical efficacy of entecavir were better than protectliver drug in patients of chronic severe-degree hepatitis B with HBeAg-positive.Entecavir can prevent severe hepatitis and hepatocirrhosis in these patients.