恩替卡韦治疗对阿德福韦酯耐药的乙肝肝硬化患者的疗效

Effect of Entecavir in the Treatment of Adefovir Dipivoxil-resistant Patients with Hepatitis B Cirrhosis

目的观察阿德福韦酯(adefovir dipivoxil,ADV)初始治疗后出现药物耐受的乙肝肝硬化患者转用替诺福韦(tenofovir disoproxil fumarate,TDF)与恩替卡韦(entecavir,ETV)治疗的临床疗效。方法选取86例ADV初始治疗后出现药物耐受的乙肝肝硬化患者为研究对象,根据其入院顺序分为观察组和对照组,各43例。观察组选用ETV进行抗病毒治疗,对照组选用TDF进行抗病毒治疗,均连续用药48周。比较2组患者不同时间点病毒学应答率、血清学应答率和生化学应答率以及治疗期间病毒学突破率和不良反应发生率。结果观察组治疗48周病毒学应答率(88.37%)和血清学应答率(76.74%),均高于对照组(69.77%、55.81%),差异有统计学意义(P<0.05);2组患者不同时间点生化学应答率差异均无统计学意义(P>0.05);对照组病毒学突破率(11.63%)高于观察组(0.00%),差异有统计学意义(P<0.05);对照组不良反应发生率(6.98%)略高于观察组(4.65%),差异无统计学意义(P>0.05)。结论ADV治疗后出现药物耐受的乙肝肝硬化患者选用ETV进行抗病毒治疗临床疗效优于TDF,且ETV药物耐受风险更低。

Objective To observe the clinical efficacy of conversion to tenofovir disoproxil fumarate(TDF)and entecavir(ETV)in patients with hepatitis B cirrhosis who developed drug tolerance after initial treatment with adefovir dipivoxil(ADV).Methods Eighty-six patients with hepatitis B cirrhosis who developed drug resistance after initial treatment with ADV were enrolled in the study.According to the order of admission,they were divided into observation group and control group(43 cases in each group).The observation group was treated with ETV for antiviral therapy,and the control group was treated with TDF for antiviral therapy for 48 weeks.The virological response rate,serological response rate and biochemical response rate of the two group patients at different time points and the virological breakthrough rate and adverse reaction rate during treatment were compared.Results The virological response rate(88.37%)and serological response rate(76.74%)in the observation group were higher than those in the control group(69.77%,55.81%).The difference was statistically significant(P<0.05).There was no significant difference in the chemical response rate at different time points(P>0.05).The virological breakthrough rate of the control group(11.63%)was higher than that of the observation group(0.00%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the control group(6.98%)and the observation group(4.65%)(P>0.05).Conclusion The clinical efficacy of ETV antiviral therapy is better than TDF for patients with hepatitis B cirrhosis who have drug resistance after ADV treatment,and the risk of ETV resistance is lower.