恩替卡韦转换为丙酚替诺福韦治疗效果稳定慢乙肝患者的临床观察

Clinical observations on chronic hepatitis B patients with stable response to Tenofovir Alafenamide treatment switching from Entecavir

目的观察恩替卡韦(ETV)转换为丙酚替诺福韦(TAF)治疗效果稳定的慢性乙型肝炎患者的临床价值。方法选择2020年8月—2021年2月在本院确诊并进行ETV治疗2年以上的慢性乙型肝炎患者93例作为研究对象,依据用药情况分为继续ETV治疗组(ETV组,47例)和转换TAF治疗组(TAF组,46例)两组,并进一步根据HBsAg基线水平分为低基线组(<800 IU/ml)和高基线组(≥800 IU/ml)。比较ETV组和TAF组患者及不同基线组治疗48周后的抗病毒效果和安全性。结果治疗48周后ETV组和TAF组患者HBsAg水平、ALT和FIB-4值比较,差异无统计学意义(P>0.05),均无病毒学突破。TAF组在治疗48周后,低基线组和高基线组HBsAg下降值分别为(0.130±0.228)logIU/ml和(0.111±0.220)logIU/ml,差异有统计学意义(P<0.05)。ETV组和TAF组患者之间不良反应相关指标在治疗48周后比较,差异无统计学意义(P>0.05)。结论HBsAg基线水平低于800 IU/ml的慢乙肝患者,可考虑将ETV转换为TAF。

Objective To investigate the clinical value of entecavir(ETV)treatment switching to tenofovir alafenamide(TAF)treatment in chronic hepatitis B patients achieve stable response.Methods 93 patients with chronic hepatitis B diagnosed in our hospital from August 2020 to February 2021 and treated with ETV for more than 2 years were selected as study subjects.They were divided into the continuous ETV treatment group(47 patients,ETV group)and the conversion TAF treatment group(46 patients,TAF group)according to the medication situation.They were further divided into the low baseline group(<800 IU/ml)and the high baseline group(≥800 IU/ml)according to the baseline level of HBsAg.The antiviral efficacy and safety of the two groups of patients and different baseline groups after 48 weeks of treatment were compared.Results There were no significant differences in ALT,HBsAg levels and FIB-4 values between the two groups at 48 weeks of treatment(P>0.05),and there was no virological breakthrough.In the TAF group,the HBsAg decline value at 48 weeks in the low baseline HBsAg subgroup was significantly higher than that in the high baseline HBsAg subgroup(0.130±0.228 and 0.111±0.220,respectively,P<0.05).There was no statistical difference in the adverse reaction-related parameters between the control group and the research group at 48 weeks of treatment(P>0.05).Conclusions We suggest that conversion of ETV to TAF may be considered in patients with baseline HBsAg levels below 800 IU/ml.