不同抗病毒药物治疗HBeAg阳性慢性乙型肝炎初治患者的疗效

Therapeutic efficacies of different antiviral drugs as initial treatment on patients with HBeAg-positive chronic hepatitis B

目的比较不同抗病毒药物治疗HBeAg阳性慢性乙型肝炎(慢乙肝)初治患者的临床疗效。方法采用回顾性队列研究,选取广州市第八人民医院HBeAg阳性慢乙肝初治患者513例,比较不同抗病毒药物治疗慢乙肝患者的病毒学应答率、HBeAg阴转率、ALT复常率,并采用COX回归模型校正基线因素的影响。结果恩替卡韦(ETV)、阿德福韦酯(ADV)、拉米夫定(LAM)、替比夫定(LdT)、干扰素(IFN)组12个月的累积病毒学应答率分别为68.94%、41.65%、46.29%、54.12%和28.87%;单因素分析显示不同抗病毒药物(x^2=67.18,P<0.05)和年龄组(x^2=20.29,P<0.05)的病毒学应答率差异有统计学意义;COX回归模型校正基线因素后显示ETV可获得更高的病毒学应答率。ETV、ADV、LAM、LdT、IFN组12个月的累积HBeAg阴转率分别为:22.73%、21.88%、13.16%、17.50%、32.00%;单因素和多因素分析的结果均显示IFN组的慢乙肝患者HBeAg阴转率高于LAM组和LdT组,ALT水平较高(2~5 ULN)的患者可获得较高的HBeAg阴转。在每个治疗时点,各组ALT复常率的差异均有统计学意义(P<0.05),ETV组获得的ALT复常率大致更高。结论 ETV在治疗HBeAg阳性的慢乙肝初治患者时可获得更高的病毒学应答率、较好的HBe Ag阴转率及ALT复常率。

Objective To compare the clinical efficacy of different antiviral drugs for initial treatment on patients with HBeAg-positive chronic hepatitis B（ CHB）. Methods A retrospective cohort study was conducted on 513 previously untreated HBeAg-positive CHB patients,who visited the eighth people＇s hospital of Guangzhou. The rates of virological response,HBeAg loss and ALT normalization were compared among different antiviral drugs,and the effects of baseline factors were corrected using the COX regression model. Results The virological response rates of patients treated with ETV,ADV,LAM,LdT and IFN for 12 months were 68. 94%,41. 65%,46. 29%,54. 12%,and 28. 87%,respectively. Univariate analysis showed a statistically significant difference in virologic response rates among different antiviral drugs（ x^2= 67. 18,P〈0. 05） and age groups（ x^2= 20. 29,P〈0. 05）. And the results of the COX regression analysis showed that ETV had higher virological response rates（ P〈0. 05） than the other antiviral drugs. The cumulative rates of HBeAg loss in the ETV,ADV,LAM,LdT and IFN groups for 12 months were 22. 73%,21. 88%,13. 16%,17. 50%,and 32. 00%,respectively. Univariate and multivariate analysis showed that the rates of HBeAg loss in patients with CHB in the IFN group was significantly higher than those in the LAM and LDT groups. And the patients with higher ALT levels（ 2-5 ULN） achieved higher rates of HBeAg loss. At each treatment time point,there were significant differences in the ALT normalization rates among the 5 groups,and higher ALT normalization rates were observed in ETV treatment. Conclusion ETV can obtain higher virological response rate,better HBeAg loss,and ALT normalization rates for treating HBeAg-positive CHB patients.