替比夫定治疗慢性乙型病毒性肝炎的近期疗效分析——附57例报告

Short-term efficacy of telbivudine on patients with chronic hepatitis B:a report of 57 cases

目的:评价替比夫定治疗慢性乙型病毒性肝炎的近期疗效。方法:57例慢性乙型病毒性肝炎患者分为HBeAg阴性组(12例)和HBeAg阳性组(45例),均予替比夫定600mg/d治疗24周,于治疗0、4、8、12、16、24周时检查HBV DNA、ALT水平,于0、12及24周检查HBeAg及HBeAb。分析上述时间点两组患者HBV DNA阴转率、ALT复常率、HBV DNA下降速度,并分析影响病毒早期应答的因素。结果:HBeAg阴性组治疗4、8、12、16、24周时的HBV DNA阴转率分别为25%、42%、50%、67%及75%;24周时ALT复常率为83%。HBeAg阳性组治疗4、8、12、16、24周时的HBV DNA阴转率分别为0、7%、13%、27%及53%;24周时HBeAg血清学转换率及ALT复常率分别为27%及76%。两组HBV DNA水平均在前4周下降最明显,其后下降速度减慢,维持在较低水平。HBV DNA阴转者的基线HBV DNA水平明显低于未阴转者(P<0.05)。结论:替比夫定可明显抑制HBV DNA的复制,并在早期(4～8周)将HBV DNA抑制到较低的水平,促进ALT恢复正常;基线HBV DNA水平是影响其24周病毒学应答的重要因素。

Objective： To investigate the short-term efficacy of telbivudine on patients with chronic hepatitis B （CHB）. Methods： Fifty-seven patients with CHB were included and assigned into HBeAg （ ＋ ） group （n = 12） and HBeAg （ - ） group （n = 45 ）. Both groups were treated with telbivudine 600 mg/d for 24 weeks. ALT and HBV DNA levels were measured on week 0, 4, 8, 12, 16 and 24, and HBeAg and HBeAb were tested on week 0, 12 and 24. The early responses rate to telbivudine therapy in both groups were assessed and compared. Further more, the affecting factors were analyzed. Results： The HBV DNA loss rate in HBeAg （ - ） group on week 4, 8, 12, 16 and 24 were 25%, 42%, 50%, 67% and 75%, respectively, while the ALT normalization rate on week 24 was 83%. The HBV DNAloss rate in HBeAg （＋） group on week 4, 8, 12, 16 and 24 were 0%, 7%, 13%, 27% and 53% , respectively. The HBeAg seroconversion rate and ALT loss rate in HBeAg （ ＋ ） group on week 24 were 27% and 76%. HBV DNA copies in both groups decreased rapidly in first 4 weeks, then slowed down, and kept at a lower level. The patients with HBV DNA loss showed significantly lower level of HBV DNA in baseline than the others （P 〈 0.05 ）. Conclusion ： For patients with CHB, telbivudine could inhibit HBV DNA reproduction in the early stage （4 -8 weeks after treatment）. Baseline HBV DNA level is an important factor affecting the early response to telbivudine.