替比夫定与恩替卡韦对乙型肝炎病毒感染患者的治疗疗效研究

Effects of telbivudine and entecavir in the treatment of patients with hepatitis B virus infections

目的探讨替比夫定与恩替卡韦对乙型肝炎病毒(HBV)感染患者血清高迁移率族蛋白-1(HMGB1)及炎症因子水平的影响。方法选取2014年6月-2015年10月于医院住院的86例HBeAg阳性慢性乙型肝炎(CHB)患者,分为替比夫定(LDT)组与恩替卡韦(ETV)组,每组43例,均给予常规保肝药物治疗,LDT组给予替比夫定,ETV组给予恩替卡韦,均治疗72周;检测血清肝功能指标及炎症因子水平,检测血清HBV DNA定量及HBV血清标记物,评定综合疗效,观察用药安全性。结果与治疗前比较,两组治疗后36、72周总胆红素(TBiL)、HMGB1、白介素-4(IL-4)、白介素-10(IL-10)水平和HBV DNA载量降低,白蛋白(ALB)、γ-干扰素(IFN-γ)水平升高(P<0.05);与同时间ETV组比较,LDT组TBiL、HMGB1、IL-4、IL-10水平和HBV DNA载量较低,ALB、IFN-γ水平较高(P<0.05);两组治疗后36、72周ALT复常率均升高(P<0.05)。结论替比夫定与恩替卡韦治疗CHB疗效相似,但替比夫定在早期抗HBV优于恩替卡韦,可能与调控HMG-1、IFN-γ等炎症介质有关。

OBJECTIVE To investigate the effects of telbivudine and entecavir in the treatment of patients with hepatitis B virus infections in serum hmgb-1（HMGB1）and inflammatory factors.METHODS A total of 86 cases of patients with chronic hepatitis B（CHB）virus infections of HBeAg-positive from Jun.2014 to Oct.2015 were selected and randomly divided into telbivudine（LDT）group and entecavir（ETV）group,with 43 cases in each group.All patients were treated with routine liver protection drugs.LDT group was treated with telbivudine,ETV group was treated with entecavir,and 2 groups were treated for 72 weeks.The serum levels of liver function and the level of inflammatory factors were detected,and the serum HBV DNA quantitative and HBV serum markers were detected to evaluate the efficacy and safety of drugs.RESULTS Compared with before treatment,levels of TBiL,HMGB1,IL-4 and IL-10,and HBV DNA load of the two groups were decreased after 36 and 72 weeks of treatment,and levels of ALB and IFN-γwere significantly increased（P〈0.05）.Compared with ETV group at the same time,levels of TBiL,HMGB1,IL-4 and IL-10,and HBV DNA load were significantly lower in LDT group,and ALB and IFN-γlevels were significantly higher（P〈0.05）.The ALT recurrence rates of the two groups after 36 and 72 weeks of treatment were significantly increased（P〈0.05）.CONCLUSION The curative effects of telbivudine and entecavir on CHB are similar,but telbivudine is better in the early stage of anti HBV than entecavir,which may be related to the regulation of HMG-1,IFN-γand other inflammatory mediators.