恩替卡韦与拉米夫定联合阿德福韦酯治疗e抗原阳性慢性乙型肝炎的疗效

Effect of entecavir and lamivudine combined with adefovir in treatment of e antigen-positive chronic hepatitis B

目的分析恩替卡韦与拉米夫定联合阿德福韦酯,治疗e抗原阳性慢性乙型肝炎患者疗效的差异,为e抗原阳性慢性乙型肝炎初治患者提供合理的治疗方案。方法将42例e抗原阳性慢性乙型肝炎患者分为恩替卡韦组与拉米夫定联合阿德福韦酯(联合组),恩替卡韦组22例,联合组20例;记录不同治疗时间两组ALT复常率、HBeAg转阴率及HBV-DNA低于检测值的患者例数,并进行比较。结果恩替卡韦组在治疗第3、6个月时ALT复常率为36.4%、77.3%,联合组为30.0%、75.0%,两组差异无统计学意义,治疗12个月后两组ALT均恢复正常水平;治疗第3、6、12个月时,恩替卡韦组HBeAg的阴性率为45.5%、77.3%、90.9%,联合组为40.0%、80.0%、100.0%,两组差异无统计学意义;治疗第6、12、24个月时,恩替卡韦组HBV-DNA阴性率为0、4.5%、22.7%、36.4%,联合组为0、5.0%、25.0%、35.0%,两组差异均无统计学意义。结论恩替卡韦与拉米夫定联合阿德福韦酯治疗e抗原阳性慢性乙型肝炎在肝酶水平、HBV血清学和病毒学转变方面的疗效差异无统计学意义。

OBJECTIVE To analyze the effect of entecavir and lamivudine combined with adefovir in the treatment of e antigen-positive chronic hepatitis B patients,so as to provide bases for the initial treatment of e antigen-positive chronic hepatitis B patients with appropriate treatment.METHODS A total of 42 cases with e antigen-positive chronic hepatitis B patients were divided into two groups： entecavir group（22 cases） and lamivudine combined with adefovir group（20 cases） according to the method of treatment;ALT normalization rates at different treatment time points were recorded,HBeAg seroconversion and the number of the patients with HBV-DNA below the detection value were compared.RESULTS The ALT normalization rates of the entecavir group in 3,6 months of treatment were 36.4% and 77.3%,the combination group 30.0% and 75.0%,the differences were not statistically significant;after the treatment for 12 moths,ALT levels were all back to normal;the negative rates of HbeAg in entecavir group were 45.5%,77.3% and 90.9% in the 3,6,and 12 moths treatment,the combination group 40.0%,80.0% and 100.0%.the differences were not statistically significant;the negative rates of HBV-DNA of entecavir group were 0,4.5%,22.7% and 36.4% in the 6,12,24 months treatment,the differences were not statistically significant.CONCLUSION There is no statistical difference in the ALT normalization,the incidence of HBeAg negative and the incidence of HBV-DNA below the detection in entecavir and lamivudine combined with adefovir for e antigen-positive chronic hepatitis HBV.