4种核苷(酸)类似物单药初治慢性乙肝方案变更分析

Regimen change analysis of four kinds of nucleoside(acid)analogues monotherapy in initial treatment of chronic hepatitis B

目的分析4种核苷(酸)类似物单药初治慢性乙型肝炎2年内方案变更情况,为临床选择治疗方案提供参考。方法根据接受初治药物不同将患者分为拉米夫定(LAM)组、阿德福韦酯(ADV)组、替比夫定(Ld T)组和恩替卡韦(ETV)组等4组,对各组患者一般临床资料、实验室检查结果、治疗方案及变更情况等进行统计分析。结果治疗1年时方案变更率依次为LAM组(24.0%)>Ld T组(20.0%)>ADV组(17.4%)>ETV组(2.0%);治疗2年时累积变更率依次为LAM组(40.0%)>Ld T组(25.6%)>ADV组(22.1%)>ETV组(3.9%),治疗1年及2年时ETV组较LAM、ADV、Ld T组有相对较低的方案变更率(P<0.01)。治疗方案变更原因:LAM、Ld T、ADV组主要为疗效因素(病毒学不完全应答/部分应答,病毒学突破);ETV组主要为经济困难。结论使用不同核苷(酸)类似物单药初治慢性乙肝,其治疗方案在2年内均出现不程度的变更,不同药物治疗方案变更原因有所差异。恩替卡韦方案变更率最低,是目前慢性乙肝首选抗病毒治疗药物。

Objective To analyze the regimen change of four kinds of nucleoside（acid）analogues monotherapy in theinitial treatment of chronic hepatitis B within two years,and to provide a reference for the selection of treatment options.Methods Depending on the acceptance of medicine,the patients were divided into lamivudine（LAM）group,adefovirdipivoxil（ADV）group,telbivudine（Ld T）group,and entecavir（ETV）group,and to analyze the clinical data,laboratory testresults,treatment and regimen change of the patients. Results The regimen change rate in 1 year： LAM group（24.0%）〉 Ld Tgroup（20.0%） 〉ADV group（17.4%） 〉ETV group（2.0%）. The cumulative change rate in 2 years： LAM group（40.0%） 〉LdT group（25.6%） 〉ADV group（22.1%） 〉ETV group（3.9%）. In 1 year and 2 years treatment,the regimen change rate of ETVgroup was relatively lower than LAM,ADV and Ld T groups（P〈0.01）. The reasons of regimen change： LAM,ADV and Ld Tgroups were mainly due to the efficacy of the treatment（incomplete virologic response / partial response,virologicalbreakthrough）; ETV group was mainly due to economic difficulties. Conclusion Use different nucleoside（acid）analoguesmonotherapy in initial treatment of chronic hepatitis B,the treatment in two years with the different degrees of change withregimens. Entecavir with lowest cumulative change rate,is currently the preferred anti-viral treatment of chronic hepatitis B.