核苷（酸）类似物初始联合与单药治疗慢性乙型肝炎144周疗效和安全性比较

The efficacy and safety comparation between Nucleoside （acid） analogue initial combination andmonotherapy in the treatment of chronic hepatitis B for 144 weeks

目的比较拉米夫定和阿德福韦酯初始联合与恩替卡韦单药治疗慢性乙型肝炎144周疗效和安全性。方法收集未曾使用抗病毒药物，且符合抗病毒治疗指证的初治慢性乙型肝炎患者120例，其中拉米夫定＋阿德福韦（LAM＋ADV）初始联合组和恩替卡韦（ETV）单药组各60例治疗144周。结果治疗144周LAM＋ADV组的HBV—DNA低于300copy／ml的检测率、HBeAg血清阴转率及转换率均高于ETV治疗组（P〈0．05），病毒突破率则低于ETV组（P〈0．05），与基线比较HBV—DNA和HBsAg下降绝对值及ALT复常率两组无统计学差异（P〉0．05），两组血清肌酐水平，及与基线比较差异均无统计学意义（P〉0．05）。结论拉米夫定和阿德福韦酯初始联合在持续病毒学应答、降低HBV—DNA、HBeAg阴转、HBeAg血清转换率及联合应答方面优于恩替卡韦单药治疗，两者在肾脏安全性方面相似。

Objective To compare the efficacy and safety of lamivudine and adefovir combined with entecavir initial monotherapy in the treatment of chronic hepatitis B for 144 weeks. Methods Collected 120 patients with chronic hepatitis initial treatment, which adefovir ＋ lamivudine （LAM ＋ ADV） initial combination group and entecavir （ETV） monotherapy treatment group for 144 weeks, 60 cases respectively. Results After treated for 144 weeks LAM ＋ ADV group beneath the 300copy/ml detection rate, HBeAg serum conversion rate and conversion rates were higher than ETV treatment group （P 〈 0.05 ）, viral breakthrough rate was lower than the ETV group （P 〈 0. 05 ） , HBV-DNA and HBsAg compared with baseline decline in absolute terms and ALT normalization had no statistical difference between the two groups （P 〉 O. 05 ）, serum creatinine in two groups had no statistical difference, serum creatinine increased compared with baseline and differences were not statistically （ P 〉 0. 05 ）. Conclusions Lamivudine and adefovir in the initial joint sustained virologic response, reducing HBV-DNA, HBeAg seroconversion and combined response rate was superior to entecavir monotherapy, both are similar in terms of renal safety.