恩替卡韦治疗慢性乙型肝炎疗效的影响因素分析

Influencing factors of efficacy to Entecavir in the treatment of patients with chronic hepatitis B

目的探讨在治疗慢性乙型肝炎患者时,影响恩替卡韦(ETV)疗效的各种因素。方法对于2007年6月至2008年5月安徽医科大学第一附属医院感染病科收治的62例使用恩替卡韦治疗的慢性乙型肝炎患者,进行回顾性分析。结果基线ALT<2×正常值上限(ULN)者与≥2×ULN者相比较,24周两组HBV-DNA低于检测下限比率分别为41.7%和71.1%(P<0.05),48周和96周两组HBV-DNA低于检测下限比率分别为65.2%、83.8%(P=0.098)和77.3%、94.4%(P=0.125);患者中,治疗24周时病毒应答率为67.6%(41/62),应答41例。应答组与未应答组于治疗48周时HBV-DNA低于检测下限比率分别为97.6%、42.9%(P<0.05),96周时为100%、72.2%(P<0.05);HBV-DNA<107copies/ml组和≥107copies/ml组比较24周、48周、96周HBV-DNA低于检测下限比率分别为85.7%和56.1%(P=0.02)、90.5%和69.2%(P=0.125)以及95.2%和85.7%(P=0.807),未见病毒学突破病例。结论恩替卡韦治疗慢性乙型肝炎有着较高的早期应答率及用药安全性,基线ALT≥2×正常值上限(ULN)者或(和)HBV-DNA<107copies/ml患者早期疗效更佳,但对于长期用药患者,远期疗效的无差距;24周病毒学应答与药物远期疗效密切相关,可为患者使用本药的长期疗效提供预判依据。

Objective To analyze the various influencing factors of efficacy to Entecavir in the treatment of patients with chronic hepatitis B.Methods All patients with chronic hepatitis B who received Entecavir monotherapy by the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed,from the June 2007 to May 2008.Results The baseline ALT〈2×the upper limit of normal value（ULN） and ≥2×ULN comparison in tow groups were detected at week 24,48 and 96,the HBV-DNA negative rates were 41.7% and 71.1%（P〈0.05）,65.2% and 83.8%（P=0.098）,77.3% and 94.4%（P=0.125）;Virological response rate was 67.6%（41/62） at week 24,HBV-DNA negative rates in the virological response at week 24 were 97.6% and 100% compared with 42.9% and 72.2% in the virological negative response at week 24 group at week 48 and 96;HBV-DNA〈107copies/ml and ≥107copies/ml in two groups were detected at week 24,48 and 96,HBV-DNA negative rates were 85.7% and 56.1%（P=0.02）,90.5% and 69.2%（P=0.125）,95.2% and 85.7%（P=0.807）.Virological breakthrough case was not detected.Conclusion Entecavir is available for anti-viral activity and safety in the treatment of patients with chronic hepatitis B.Early therapeutic effect is better for the patients whose baseline ALT≥2×ULN and HBV-DNA〈107 copies/ml,Long-term efficacy is insignificant on the patients with long-term treatment.Virological response at week 24 is in close touch with long-term therapeutic effect,which can provide prejudgment for long-term therapeutic effects of Entecavir.