替比夫定与恩替卡韦治疗慢性乙型肝炎对病毒载量的影响分析

Influence of viral load of telbivudine and entecavir in treatment of chronic hepatitis B

目的研究替比夫定与恩替卡韦治疗乙肝e抗原(HBeAg)阳性慢性乙型肝炎对病毒裁量的影响,以确定两种药物交替使用的治疗方案。方法选取2012年6月-2014年6月医院收治的HBeAg阳性慢性乙型肝炎患者200例,根据治疗方法分为替比夫定组102例和恩替卡韦组98例,两组均治疗24周,检测患者血清中谷丙转氨酶(ALT)水平、HBeAg水平以及乙肝病毒e抗体(抗-HBe)水平,并计算ALT复常率、HBeAg消失率及HBeAg/抗-Hbe转换率,应用实时荧光定量PCR法检测治疗前后两组患者乙肝病毒脱氧核糖核酸(HBVDAN)定量,另外,应用单因素和多因素分析治疗12周和24周病毒载量对临床疗效的影响。结果两组患者治疗24周时,血清ALT复常率比较差异均无统计学意义;替比夫定组血清HBeAg消失率以及HBeAg/抗-Hbe转换率均显著高于恩替卡韦组,两组比较差异有统计学意义(P<0.05);单因素分析显示,治疗12周和24周时HBV-DNA是影响替比夫定治疗HBeAg阳性慢性乙型肝炎疗效的影响因素(P<0.05),治疗24周时HBVDNA是恩替卡韦治疗HBeAg阳性慢性乙型肝炎疗效的影响因素(P<0.05)。结论治疗12周病毒载量对替比夫定治疗疗效有影响,治疗24周时病毒载量对恩替卡韦和替比夫定治疗疗效均有影响,临床应及时检测病毒载量以确保药物的临床疗效,并合理交替使用药物。

OBJECTIVE To study the effect of viral load of telbivudine and entecavir on chronic hepatitis B with HBeAg positive,so as to make the treatment plan of alternate use two medicines.METHODS A total of 200 patients with HBeAg positive chronic hepatitis B from Jun.2012 to Jun.2014 in our hospital were divided into the telbivudine group（102cases）and entecavir group（98cases）according to the treatment methods,and the two groups were treated for 24 weeks.The level of serum alanine aminotransferase（ALT）,HBeAg and hepatitis B virus E antibody（anti-HBe）were detected,and the ALT normalization rate,HBeAg disappear rate and HBeAg/anti-HBe conversion rate were calculated.The HBV DNA ration of two groups of patients before and after the treatment was tested by real-time fluorescent quantitative PCR method.In addition,using univariate and multivariate to analyze clinical efficacy of 12 weeks and 24 weeks of viral load.RESULTS After 24 weeks of treatment,serum ALT recovery rate differences were not significant;serum HBeAg disappearance rate and HBeAg/anti HBE conversion rates of the telbivudine group were significantly higher than the entecavir group（P〈0.05）.Single factor analysis showed that treatment for 12 weeks and 24 weeks,HBV DNA was the influence factor to effect telbivudine on HBeAg positive chronic hepatitis B（P〈0.05）,and treatment for 24 weeks,HBV-DNA was entecavir treatment factors affecting the efficacy of HBeAg positive chronic hepatitis B（P〈0.05）.CONCLUSIONThe treatment of 12 weeks of viral load has influence on telbivudine treatment,and 24 weeks of treatment has influence on viral load on entecavir and telbivudine treatment.Viral load should be timely detected in clinic in order to ensure the clinical curative effect of drugs,and reasonably use in an alternate way.