艾米替诺福韦片联合聚乙二醇干扰素α-2b治疗慢性乙型病毒性肝炎的临床疗效观察

Clinical efficacy of emittenofovir tablets combined with peginterferon α-2b in the treatment of chronic viral hepatitis B

目的 探讨艾米替诺福韦片联合聚乙二醇干扰素α-2b治疗慢性乙型病毒性肝炎(chronic hepatitis B, CHB)的治疗效果。方法 回顾性分析2021年8月—2023年6月于我院进行治疗的CHB患者110例。按照治疗方案的不同,将患者分为艾米替诺福韦组(56例)与联合治疗组(54例)。艾米替诺福韦组给予口服艾米替诺福韦片治疗。联合治疗组在艾米替诺福韦组治疗基础上加用聚乙二醇干扰素α-2b注射液。对比治疗24周和48周后2组患者的临床疗效。结果 治疗24周后,联合治疗组与艾米替诺福韦组的患者乙型肝炎病毒e抗原(hepatitis B e antigen, HBeAg)转阴率、乙型肝炎病毒表面抗原(hepatitis B surface antigen, HBsAg)清除率以及乙型肝炎病毒(hepatitis B virus, HBV)脱氧核糖核酸(deoxyribonucleic acid, DNA)转阴率比较,差异均无统计学意义(P均> 0.05);治疗48周后,联合治疗组患者HBe Ag转阴率为38.9%,HBs Ag清除率为22.2%,均显著优于艾米替诺福韦组(HBe Ag转阴率16.1%、HBs Ag清除率1.8%)(P均<0.05);联合治疗组与艾米替诺福韦组的患者HBV DNA转阴率分别为98.1%和92.9%,差异无统计学意义(P> 0.05);治疗24周后,联合治疗组与艾米替诺福韦组的患者总胆红素(total bilirubin, TBIL)、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase, AST)及谷氨酰胺转移酶(gamma-glutamyl transpeptidase, GGT)水平之间差异均无统计学意义(P均> 0.05);治疗48周后,联合治疗组患者的TBIL、ALT、AST及GGT水平均显著高于艾米替诺福韦组(P均<0.05)。艾米替诺福韦组的不良反应率为14.3%,显著低于联合治疗组的96.3%(P=0.000)。结论 艾米替诺福韦片联合聚乙二醇干扰素α-2b治疗CHB的临床疗效显著优于单独使用艾米替诺福韦片,但不良反应发生率较高。

Objective To explore the clinical efficacy of amitinofovir tablets combined with peg-interferonα-2b in the treatment of chronic viral hepatitis B.Methods A retrospective analysis was conducted on 110 patients with chronic viral hepatitis B treated in our hospital from August 2021 to June 2023.According to the different treatment regiments,the patients were divided into the amitinofovir group(56 cases)and the combination therapy group(54 cases).The amitinofovir group was given oral amitinofovir tablets treatment,25 mg each time,once a day.In the combination treatment group,polyethylene glycol interferonα-2b injection was added to the treatment of the Amitinofovir group.The clinical efficacy of these 2 groups was compared with the treatment after 24/48 weeks of treatment.Results After 24 weeks of treatment,there was no significant difference in hepatitis B e antigen(HBeAg)conversion rate,hepatitis B surface antigen(HBsAg)clearance rate and HBV DNA conversion rate between the combination treatment group and the emitenofovir group(P>0.05).After 48 weeks of treatment,the HBeAg conversion rate and HBsAg clearance rate of patients in the combination treatment group were 38.9%and 22.2%,which were significantly better than those in the emitenofovir group(16.1%and 1.8%,P<0.05),and the HBV DNA conversion rates in the combination treatment group and the emitenofovir group were 98.1%and 92.9%,respectively,with no significant difference(P>0.05).After 24 weeks of treatment,there was no significant difference in total bilirubin(TBIL)level,alanine aminotransferase(ALT)level,aspartate aminotransferase(AST)level and gamma-glutamyl transpeptidase(GGT)level between the combination treatment group and the emitenofovir group(P>0.05).After 48 weeks of treatment,the levels of TBIL,ALT,AST and GGT in patients with chronic viral hepatitis B in the combination treatment group were significantly higher than those in the emitenofovir group(P<0.01).The adverse reactions of the emitenofovir group in the treatment of chronic viral hepatitis B were 14.3%,which was significantly lower than that in the combination group(96.3%)(P<0.00).Conclusions The clinical efficacy of amitinofovir tablets combined with peg-interferonα-2b in the treatment of chronic viral hepatitis B is significantly better than that of amitinofovir tablets alone,but the incidence of adverse reactions is higher.