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疗效比较

Efficacy of entecavir and lamivudine combined with adefovir dipivoxil in the treatment of e antigen positive ;chronic hepatitis B

目的：比较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的疗效。方法将72例 e 抗原阳性慢性乙型肝炎患者采用数字表法分随机为Ⅰ组36例和Ⅱ组36例，Ⅰ组采用恩替卡韦治疗，Ⅱ组采用阿德福韦酯和拉米夫定治疗，两组均治疗24个月，比较两组治疗后6个月、12个月、24个月 HBV-DNA 转阴率、ALT 复常率、HBeAg 转阴率、HBsAg 转阴率、HBeAg 与 HBeAb 转换率。结果两组治疗后6个月、12个月、24个月的 HBV-DNA 转阴率、HBeAg 转阴率、HbeAg 及 HBeAb 转换率差异均无统计学意义，但Ⅰ组治疗后6个月、12个月 ALT 复常率分别为52．78％、83．33％，明显高于Ⅱ组的27．78％、38．89％，差异均有统计学意义（χ2＝4．677、14．961，均 P ＜0．05）。Ⅰ组治疗后6个月、12个月、24个月总应答率分别为47．22％、77．78％、88．89％，Ⅱ组分别为44．44％、72．22％、83．33％，两组差异均无统计学意义（均 P ＞0．05）。结论拉米夫定联合阿德福韦酯对 e 抗原阳性慢性乙型肝炎初治患者的抗病毒疗效与恩替卡韦相似，均能明显抑制 HBV 复制、改善肝功能，且安全性均良好，但恩替卡韦早期 ALT 复常率更高，应根据临床实际情况选择。

Objective To compare the effect of entecavir and lamivudine combined with adefovir in treatment of patients with e antigen -positive chronic hepatitis B.Methods 72 patients with HBeAg positive chronic hepatitis B were randomly divided into group Ⅰ （36 cases）and group Ⅱ （36 cases）.Group Ⅰ was treated by grace entecavir,group Ⅱ was treated with adefovir and lamivudine,two groups were treated for 24 months.The HBV -DNA negative rate,ALT recovery rate,HBeAg seroconversion rate,negative conversion rate of HBsAg,HBeAg and HBeAb conversion rate of the two groups were compared after 6 months,12 months and 24 months treatment.Results After treatment for 6 months,12 months and 24 months,the HBV -DNA negative rate,HBeAg negative conversion rate, HBeAg and HBeAb rate in the two groups had no statistically significant differences.After 6 months and 12 months treatment,the ALT recovery rates of group Ⅰ were 52.78%,83.33%,which were significantly higher than 27.78%, 38.89% of group Ⅱ,the differences were statistically significant（χ2 =4.677,14.961,all P 〈0.05 ）.The total response rates of 6 months,12 months and 24 months after treatment were 47.22%,77.78%,88.89%,72.22%, 83.33% and 44.44%,respectively.There were no significant differences between the two groups（all P 〉0.05）. Conclusion There is similar effect of entecavir and lamivudine combined with adefovir in treatment of patients with e antigen -positive chronic hepatitis B,which can inhibit HBV replication and improve liver function,and the security was good,but entecavir has better ALT normalization rate at early,the treatment should be selected according to clini-cal practice.