替诺福韦与恩替卡韦初始治疗慢性乙肝患者的疗效比较

Comparative Analysis of Tenofovir and Entecavir in the Initial Treatment of Chronic Hepatitis B Patients

目的比较替诺福韦(TDF)和恩替卡韦(ETV)初始治疗慢性乙型肝炎(CHB)患者96周的疗效。方法选择我院108例CHB患者,其中接受TDF初始治疗48例,ETV初始治疗60例。比较两组患者治疗第12周、24周、36周、48周、72周和96周时ALT、HBV DNA变化和病毒学应答(VR)率发生情况。结果治疗12周时,TDF组ALT水平为(83.3±9.8)U/L低于ETV组(101.6±10.7)U/L(P<0.05),TDF组HBV DNA水平为(2.1±1.2)lg IU/mL低于ETV组(3.2±0.9)lg IU/mL(P<0.05),治疗12周后TDF组与ETV组ALT、HBV DNA水平均无统计学差异(P>0.05);治疗12周时,TDF组VR率为41.7%显著高于ETV组21.7%(P<0.05),治疗12周后ETV组与TDF组VR无统计学差异(P>0.05);Kaplan-Meier生存分析发现治疗96周TDF组达到完全VR时间为(28.6±3.5)周,ETV组达到完全VR时间为(34.9±3.5)周,两组总体累计完全VR率无统计学差异(P>0.05)。结论ETV和TDF对CHB患者在96周的初始疗效相当,但TDF比ETV能更早的使HBV DNA和ALT恢复正常。

Objective To compare the efficacy of tenofovir(TDF)and entecavir(ETV)in the initial treatment of patients with chronic hepatitis B(CHB)for 96 weeks.Methods A retrospective study was conducted on 108 CHB patients who received treatment,of which 48 received TDF treatment and 60 patients received initial ETV treatmet.The ALT,HBV DNA changes and the occurrence of virological response(VR)rates at the 12 th,24 th,36 th,48 th,72 nd and 96 th week after treatment were compared between the two groups of patients.Results At the 12 th week after treatment,the ALT level of the TDF group was lower than that of the ETV group[(83.3±9.8)U/L vs(101.6±10.7)U/L,P<0.05],and the HBV DNA level of the TDF group was lower than that of the ETV group[(2.1±1.2)lg IU/mL vs(3.2±0.9)lg IU/mL,P<0.05],there was no significant difference in ALT and HBV DNA levels between the TDF group and the ETV group after 12 weeks of treatment(P>0.05);At 12 weeks after treatment,the VR rate of the TDF group was significantly higher than that of the ETV group(41.7%vs.21.7%,P<0.05).After 12 weeks of treatment,there was no significant difference in VR between the ETV group and the TDF group(P>0.05);Kaplan-Meier survival analysis found after 96 weeks of treatment,the time to reach complete VR in the TDF group was(28.6±3.5)weeks,and the time to reach VR in the ETV group was(34.9±3.5)weeks.There was no significant difference in the overall cumulative complete VR rate between the two groups(P>0.05).Conclusion ETV and TDF are equally effective in initial treatment of CHB patients at 96 weeks,but TDF can reduce HBV DNA and ALT to normal earlier than ETV.