恩替卡韦治疗45例慢性乙型重型病毒性肝炎的疗效观察

Entecavir for chronic severe viral hepatitis B:clinical observation of 45 cases

目的:评价恩替卡韦治疗慢性乙型重型病毒性肝炎的临床疗效。方法:45例患者在常规治疗的基础上给予恩替卡韦0.5mg,每日1次口服;另47例给予拉米夫定100mg,每日1次口服,存活患者的治疗时间不少于6个月。结果:恩替卡韦组临床疗效总有效率为80.0%,显著高于拉米夫定组总有效率66.0%(P<0.05);总胆红素(TBIL)和谷丙转氨酶(ALT)分别由治疗前的378.2±36.3umol/L和546.8±56.5 U/L降至146.5±35.4μmol/L和46.5±21.5U/L,凝血酶原活动度(PTA)由治疗前的32.5±5.8%升至59.5±16.8%,均较拉米夫定组改善明显(P<0.05);恩替卡韦组的HBeAg和HBV-DNA转阴率分别为71.4和66.7%,明显高于拉米夫定组的47.6%和45.2%(P<0.05)。病死率分别为6.7%和10.6%,无显著性差异(P>0.05)。结论:恩替卡韦治疗慢性乙型重型肝炎患者在临床疗效、肝功能改善和抑制病毒复制方面均优于拉米夫定治疗者。

Objective： To evaluate the clinical effect of entecavir（ETV）in the treatment for patients with chronic severe hepatitis B.Methods： Forty-five patients with chronic severe hepatitis B were treated with entecavir（ETV） at dose of 0.5 mg daily besides conven-tional therapy for at least 6 months,while Forty-seven patients were treated with lamivudine（LVD）100 mg as the control group.Results： The entecavir clinical efficacy of the total effective rate was 80.0%,significantly higher than the lamivudine group,the total efficiency of 66.0%（P 0.05）;The average levels of total bilirubin（TBIL） and alanine amino-transferase（ALT） decreased from 378.2±36.3umol/L and 546.8±56.5U/L before therapy to 146.5±35.4μmol/L and 46.5±21.5 U/L,the prothrombin activity（PTA） increased from 32.5 ± 5.8% before therapy to 59.5 ± 16.8% after therapy in entecavir group,which were more obvious than in lamivudine group（P0.05）.The loss of HBeAg and HBV-DNA in entecavir group（71.4% and 69.8%）was higher than in lamivudine group（47.6% and 45.2%,P0.05）.There was no significant difference in death rates between the two groups（6.7% versus 10.6%,P0.05）.Conclusioins： In the treatment of patients with chronic severe hepatitis B,entecavir is superior to lamivudine.