恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎患者的临床观察

Clinical observation of Entecavir in treatment of e-antigen positive chronic viral hepatitis B

目的:观察恩替卡韦治疗e抗原(HBe Ag)阳性慢性乙型病毒性肝炎患者的临床疗效。方法:选取98例e抗原阳性慢性乙型病毒性肝炎患者为研究对象,采用抽签随机法均分为观察组和对照组,每组各49例。对照组患者给予阿德福韦酯治疗;观察组患者采用恩替卡韦进行治疗。两组患者均持续治疗24周。治疗后,比较两组患者的各项指标(HBe Ag阴转率、HBe Ag血清学转换率、HBV DNA阴转率、ALT复常率)变化情况;以及观察治疗前后,两组患者的血清白细胞介素-12(IL-12)、白细胞介素-10(IL-10)、γ干扰素(IFN-γ)水平;同时观察两组患者用药后不良反应发生情况。结果:治疗24周后,观察组患者的HBe Ag阴转率77.55%、HBe Ag血清学转换率24.49%、HBV DNA阴转率81.63%、ALT复常率85.71%与对照组比较,除ALT复常率差异无统计学意义(P>0.05),其它观察指标差异明显(P<0.05)。治疗后,两组患者的血清IL-12、IFN-γ均较治疗前明显上升,IL-10较治疗前下降;观察组患者的血清IL-12(82.35±31.29)ng/L、IFN-γ(17.21±3.91)ng/L均较对照组上升明显(P<0.05);IL-10(34.29±15.68)ng/L与对照组比较,差异无统计学意义(P>0.05)。观察组患者的不良反应总发生率与对照组比较,差异无统计学意义(P>0.05)。结论:恩替卡韦治疗HBe Ag阳性慢性乙型病毒性肝炎患者的临床疗效优于阿德福韦酯。

Objective： To observe clinical effects of Entecavir intreatment of e-antigen（ HBe Ag） positive chronic viral hepatitis B. Methods： 98 patients with e-antigen positive chronic viral hepatitis B were selected as the study subjects. According to the random sampling method,they were divided into the observation group（ n = 49） and the control group（ n = 49）. The control group was treated with Adefovir Dipivoxil,while the observation group was treated with Entecavir. The two groups were continuously treated for24 weeks. The changes of indexes（ negative conversion rate of HBe Ag,serological conversion rate of HBe Ag,negative conversion rate of HBV DNA,normalization rate of ALT） before and after the treatment were compared between the two groups. The changes of serum cytokines [interleukin-12（ IL-12）,interleukin-10（ IL-10）,interferon gamma（ IFN-γ） ] in the two groups before and after the treatment were observed. Meanwhile,the occurrence of adverse reactions in the two groups after medication was observed. Results： After 24 weeks＇ treatment,the negative conversion rate of HBe Ag（ 77.55%）,serological conversion rate of HBe Ag（ 24.49%）,negative conversion rate of HBV DNA（ 81.63%） and normalization rate of ALT（ 85.71%） in the observation group were significantly higher than those in the control group. Except that the difference in normalization rate of ALT was not significant（ P〈0.05）,the differences in other indexes between the two groups were significant（ P〈0.05）. After the treatment,the levels of the serum IL-12 and IFN-γ in the two groups were significantly higher than those before the treatment,while the levels of IL-10 were lower than those before the treatment. The increases of serum IL-12（ 82.35±31.29） ng/L and IFN-γ（ 17.21±3.91） ng/L in the observation group were more significant than those in the control group（ P〈0.05）,while the level of IL-10（ 34.29±15.68） ng/L was lower than that in the control group（ P〈0.05）. There was no statistical difference in the incidence of adverse reactions between the two groups（ P〈0.05）. Conclusions：The clinical effects of Entecavir in the patients with HBe Ag positive chronic viral hepatitis B are better than Adefovir Dipivoxil.