e抗原阳性慢性乙型肝炎替比夫定初治的抗病毒疗效

Efficacy and Follow-up of changes in renal function of telbivudine in treatment for patients with HBe Ag positive chronic hepatitis B

目的观察e抗原阳性慢性乙型肝炎替比夫定初治的抗病毒疗效。方法将30例HBe Ag阳性的慢性乙型肝炎患者,根据1∶1∶1随机分为替比夫定(LDT)单药组、替比夫定联合阿德福韦酯(LDT+ADV)组、拉米夫定联合阿德福韦酯(LAM+ADV)组,每组10例,疗程均为96周。观察各组治疗12、24、48、72、96周时ALT复常率、HBV-DNA转阴率、HBe Ag/抗-HBe血清学转换、肾小球滤过率。结果在48周时,3组病毒学应答率均达到100%。替比夫定组最先出现生化学应答,在48周后,3个治疗组均达到100%。血清学应答在72周时,替比夫定组(50%)明显高于替比夫定联合阿德福韦酯组(40%)、拉米夫定联合阿德福韦酯组(0%),差异具有统计学意义(P<0.05)。96周后替比夫定组肾小球滤过率(112.26±2.86)ml/(min·1.73 m2)较基线明显升高,替比夫定联合阿德福韦酯组(100.65±2.61)ml/(min·1.73 m2)较基线逐渐升高,拉米夫定联合阿德福韦酯组(92.03±2.08)ml/(min·1.73 m2)基本无变化。结论替比夫定具有强效、快速抑制HBV DNA复制,并有高效的e抗原血清转换作用,替比夫定单药或联合阿德福韦酯,可明显提高患者的肾小球滤过率,进而改善肾功能。

Objective To evaluate the efficacy and changes in renal function of telbivudine for patients with HBe Ag positive chronic hepatitis B（ CHB）. Methods 30 patients were randomized into telbivudine（ LDT） monotherapy group（ 10 patients）,telbivudine plus adefovir（ LDT ＋ ADV） combination therapy group（ 10 patients）,and lamivudine plus adefovir（ LAM ＋ ADV） combination therapy group（ 10 patients） for 96 weeks. Serum ALT normalization rate,rate of undetectable HBV-DNA,HBe Ag / anti-HBe seroconversion rate,glomerular filtration rate（ GFR） were detected at 12,24,48,72,96 weeks,respectively. Results The virological response rates in the three groups were 100% at weeks 48. LDT monotherapy group first exhibited biochemical response. After 48 weeks,biochemical response in the three group reached 100%. Serological response in LDT monotherapy group（ 50%） was significantly higher than in telbivudine plus adefovir combination therapy group（ 40%） and lamivudine plus adefovir combination therapy group（ 0%） at 72 weeks. After 96 weeks,GFR in Telbivudine monotherapy group（ 112. 26 ± 2. 86） ml /（ min ·1. 73 m2） was significantly higher than baseline; GFR in telbivudine plus adefovir combination therapy group（ 100. 65 ± 2. 61） ml /（ min·1. 73 m2） gradually increased from baseline; and unchanged in lamivudine plus adefovir combination therapy group（ 92. 03 ± 2. 08） ml /（ min · 1. 73 m2）.Conclusions Telbivudine can a potently and rapidly inhibit HBV DNA replication,and is efficient in e antigen seroconversion rate.Telbivudine monotherapy or combined with adefovir can significantly improve the patients＇ glomerular filtration rate,and thus improve renal function.