恩替卡韦和替比夫定抗病毒治疗中HBeAg血清学转换影响因素探讨

The factors affecting HBeAg seroconversion during antiviral therapy using nucleoside analogues

目的分析恩替卡韦和替比夫定治疗慢乙肝过程中血清HBV DNA和HBeAg含量的变化及其联系,探讨二者对HBeAg血清学转换的作用及其在抗病毒治疗中的价值及临床意义。方法选择分别应用恩替卡韦治疗(53例)和替比夫定治疗(31例)的HBeAg阳性慢性乙型肝炎(CHB)患者共84例,观察治疗后48周内发生HBeAg血清转换者和无HBeAg血清转换者不同时间点HBV DNA下降水平及其转阴率、血清HBV DNA载量与HBeAg水平的关联。结果 HBV DNA在核苷类似物治疗早期迅速下降;发生HBeAg血清转换者较无转换者HBV DNA下降幅度大,HBV DNA转阴率高;基线血清HBV DNA和HBeAg含量成正相关(r=0.49,P<0.05),治疗48周后相关性消失;HBeAg血清学转换与基线血清HBV DNA、HBeAg定量以及治疗12周后的HBV DNA转阴率有关。结论发生HBeAg血清学转换者较无转换者HBV DNA下降速度快,病毒转阴率高,基线HBeAg、HBV DNA载量低,可通过观察HBV DNA下降水平和转阴率预测核苷类似物的治疗效果。

Objective To analyze the relationship between serum HBV DNA and HBeAg levels at different time points after entecavir and telbivudine therapy,and discuss their value and clinical significance in HBeAg seroconversion. Methods A total of 84 HBeAg positive chronic hepatitis B（CHB） patients were selected,.including 53 treated with entecavir and 31 treated with telbivudine..Among the 48-week treatment,.serum HBV DNA levels were measured at baseline, week 4,8,12,24 and 48..The correlation between serum HBV DNA and HBeAg levels,differences of HBV DNA reduction,and negative conversion rate of virus between HBeAg seroconversion group and non-seroconversion group were analyzed. Results In early of the treatment,.HBV DNA decreased sharply,.and the downward trend was greater in the seroconversion group than the non-seroconversion group,.as well as the negative conversion rate of virus..A significant correlation with the baseline HBV DNA and qHBeAg was observed （r=0.49,P0.05）,but it disappeared after 48-week therapy. HBeAg seroconversion corelated with baseline HBV DNA and qHBeAg,as well as the negative conversion rate of virus after 12 weeks treatment. Conclusion HBeAg seroconversion group has a greater decline trend,negative rate of virus, and lower baseline of HBV DNA and quantitative of HBeAg.