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[摘要]
目的 对比观察替比夫定(LdT)联合阿德福韦酯(ADV)治疗青年高病毒载量乙型肝炎e抗原(HBeAg)阳性慢性乙型病毒性肝炎(CHB)的疗效。方法 106例HBeAg阳性、HBV DNA≥107 拷贝/mL的青年CHB初治患者分为替比夫定(LdT)联合阿德福韦酯(ADV)联合治疗组(54例)和恩替卡韦(ETV)对照组(52例)。联合治疗组口服LdT 600 mg/d+ADV 10 mg/d,1次/d;对照组口服ETV 0.5 mg/d,1次/d。总疗程48周,观察两组患者治疗12、24、36、48周时乙型病毒性(HBV)DNA阴转率、HBeAg血清学转换率及丙氨酸氨基转移酶(ALT)的复常率。结果 治疗后,两组患者均取得较好的疗效,获得较高的HBV DNA转阴率和ALT复常率。在治疗第12、24、36、48周时两组的HBV DNA阴转率及ALT复常率比较,差异均无统计学意义;但联合治疗组HBeAg血清学转换率24周后明显高于ETV对照组(33.3% vs 13.5%,χ2=5.804、P=0.016),差异有统计学意义,且36周和48周统计学差异更加显著(42.6% vs 15.4%,χ2=9.477、P=0.002;48.1% vs 19.2%,χ2=9.877、P=0.002)。结论 替比夫定联合阿德福韦酯治疗青年高病毒载量的初治HBeAg阳性CHB患者,不仅获得较高的病毒学应答率和肝功能复常率,与恩替卡韦相比还能获得更高的HBeAg血清转换率。
[Key word]
[Abstract]
Objective To compare the clinical efficacy of telbivudine combined with adefovir and entecavir alone in young adult patients with Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B and high levels of hepatitis B virus (HBV) DNA. Methods Totally 106 young adult patients with HBeAg positive chronic hepatitis B and HBV DNA ≥ 107copies/mL) were divided into two groups, and 54 patients received combination therapy with telbivudine (600 mg/d) and adefovir dipivoxil (10 mg/d), while 52 patients received entecavir (0.5 mg/d) monotherapy. All the patients were treated for at least 48 weeks. The HBV DNA negative-conversion rate, alanine amino transferase (ALT) normalization rate, and HBeAg seroconversion rate were observed at 12, 24, 36, and 48 weeks. Results After the treatment, the levels of ALT and HBV DNA were significantly decreased in both groups. There were no statistical significances in the rates of HBV-DNA negative conversion and ALT normalization between the two groups at week 12, 24, 36, and 48 (P>0.05 for all). The HBeAg seroconversion rate in the combination group was significantly higher than that in entecavir group at week 24(33.3% vs 13.5%, χ2=5.804, P=0.016), 36 (42.6% vs 15.4%, χ2=9.477, P=0.002) and 48 (48.1% vs 19.2%, χ2=9.877, P=0.002), respectively. Conclusion In young adult patients with HBeAg positive chronic hepatitis B and high levels of HBV DNA, the treatment of telbivudine combined with adefovir achieved not only high HBV-DNA negative-conversion rate and ALT normalization rate, but also higher HBeAg seroconversion rate than entecavir did.
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[基金项目]
福建省重点课题(2016Y0068)