不同核苷(酸)类药物治疗乙肝相关性肝癌的效果与成本效益的比较研究

A comparative study on the efficacy and cost-effectiveness of different nucleoside (acid) drugs in the treatment of hepatitis B-related hepatocellular carcinoma

目的探讨不同核苷(酸)类药物治疗乙肝相关性肝癌的效果和成本效益。方法选取200例乙肝相关性肝癌患者,按随机数表法分为替比夫定(LDT)组、恩替卡韦(ETV)组、拉米夫定(LMV)组、阿德福韦酯(ADV)组,各50例。利,记录治疗144周后4组患者的肝功能指标水平、HBV DNA转阴率、成本以及不良反应发生情况。结果治疗144周后,ETV组、LMV组、LDT组、ADV组肝功各项指标水平比较,差异有统计学意义(P<0.05);4组治疗48、96、144周的HBV DNA转阴率均呈现逐渐升高的趋势,治疗144周后,ETV组、LMV组、LDT组、ADV组的HBV DNA转阴率分别为90.2%、85.3%、79.6%、60.5%,差异有统计学意义(P<0.05);ETV组、LMV组、LDT组、ADV组治疗144周的成本分别为39 826.8、16 145.9、24 731.6、19 819.8元,差异有统计学意义(P<0.05);ETV组、LMV组、LDT组、ADV组治疗144周的疗效分别为86.7%、26.3%、10.4%、7.2%;C/L分别为459.4、613.9、2 378.1、2 752.8,差异有统计学意义(P<0.05),ETV的效价是最好的,次之是LMV;ETV组、LMV组、LDT组、ADV组不良反应发生率比较,差异无统计学意义(P>0.05)。结论对乙肝相关性肝癌患者的治疗,结合成本低、副作用少、疗效好等方面进行分析,ETV的效价较好,其次是LMV。

Objective To explore the efficacy and cost-effectiveness of different nucleoside （acid） drugs in the treatment of hepatitis B related liver cancer. Methods A total of 200 patients with HBV associated hepatocellular carcinoma patients were selected as the subjects, and the 200 cases were randomly divided into telbivudine（LDT） group, entecavir（ETV） group, lamivudine（LMV） group and adefovir dipivoxil（ADV） group. The ALT, ALB, AST, GGT, HBV DNA negative rate, the cost and the incidence of adverse reactions of the four groups were recorded after treatment in 144 weeks. Results The numerical changes of liver function indicators of ETV group, LMV group, LDT group, ADV group had statistical significance after treatment in 144 weeks（ P 〈0.05 ）. HBV DNA negative rate were increased gradually of four groups in 48 weeks, 96 weeks and 144 weeks of the treatment process. ETV group, LMV group, LDT group, ADV group, HBV group of four DNA negative rates were 90.2%, 85.3%, 79.6%, 60.5% after treatment in 144 weeks, and difference was statistically significant （ P 〈0.05 ）. The total costs of ETV group, LMV group, LDT group, ADV group were 39 826.8 yuan, 16 145.9 yuan, 24 731.6 yuan, 19 819.8 yuan in the treatment for 144 weeks, and difference was statistically significant （ P 〈0.05 ）. The curative effect statistics of ETV group, LMV group, LDT group and ADV group were 86.7%, 26.3%, 10.4%, and 7.2%. The combination of cost and effect of ETV group, LMV group, LDT group and ADV group were 459.4, 613.9, 2 378.1, 2 752.8, and the difference was statistically significant （ P 〈0.05 ）. The effect and cost showed that the ETV was the best, the second was LMV. Adverse reaction of ETV group, LMV group, LDT group, ADV group were 4%, 6%, 4%, 6%, and the difference was not statistically significant （ P 〉0.05 ）. Conclusion For patients with hepatitis B related liver cancer, combined with low cost, less side effects, good efficacy and other aspects of analysis, ETV is better, followed by LMV.