本文選題：慢性乙型病毒性肝炎　切入點(diǎn)：聯(lián)合應(yīng)答　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究旨在評估HBeAg陽性的慢乙肝患者經(jīng)核苷類似物治療后發(fā)生聯(lián)合應(yīng)答(包括HBVDNA轉(zhuǎn)陰、ALT復(fù)常和HBeAg血清學(xué)轉(zhuǎn)換)的情況,并且了解延長治療時(shí)間對于提高聯(lián)合應(yīng)答率是否有效。方法:總共有280例從2004年8月至2014年2月在重慶醫(yī)科大學(xué)第二附屬醫(yī)院感染科隨訪治療HBeAg陽性的慢性乙型病毒性肝炎患者進(jìn)入研究,190例經(jīng)恩替卡韋單藥治療,90例經(jīng)替比夫定單藥治療。收集所有患者基線人口學(xué)特征、臨床及實(shí)驗(yàn)室檢查資料,根據(jù)患者基線HBVDNA和ALT的水平,將280例患者分為優(yōu)勢人群和非優(yōu)勢人群組,使用SSPSS22.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。結(jié)果:Kaplan-Meier統(tǒng)計(jì)分析顯示,在總?cè)巳褐械?年累積聯(lián)合應(yīng)答率是8.6%,第2年是13.2%,第3年是19.1%,第4年是24.2%,第5年是26.0%。在優(yōu)勢人群中,前3年的聯(lián)合應(yīng)答率明顯高于非優(yōu)勢人群(P=0.043),3年之后兩組人群聯(lián)合應(yīng)答率無差異。并且在優(yōu)勢人群中聯(lián)合應(yīng)答主要發(fā)生在前3年。多因素cox回歸分析表明在優(yōu)勢人群中第1年發(fā)生HBeAg血清學(xué)轉(zhuǎn)換是發(fā)生聯(lián)合應(yīng)答唯一相關(guān)因素(Hazard ratio[HR],16.321;P=0.000)。經(jīng)過3年的核苷類似物治療,基線APRI評分≤0.5患者的比例到第三年從15.6%增加至71.3%,基線APRI評分1.5患者的比例到第三年從43.8%下降至1.9%。結(jié)論:核苷類似物治療HBeAg陽性的慢性乙型肝炎患者從3到5年提高聯(lián)合應(yīng)答率是有限的,尤其針對優(yōu)勢人群。因此尋求新的轉(zhuǎn)換治療方案是必要的。
[Abstract]:Objective: to evaluate the combined response of HBeAg positive patients with chronic hepatitis B after treatment with nucleoside analogues (including the return of HBVDNA to negative alt and HBeAg serological conversion). Methods: from August 2004 to February 2014, a total of 280 patients with HBeAg positive chronic type B were followed up from August 2004 to February 2014 in the second affiliated Hospital infection Department of Chongqing Medical University. Patients with viral hepatitis entered the study of 190 patients treated with entecavir alone and 90 patients received tibiff order. Baseline demographic characteristics of all patients were collected. According to the level of HBVDNA and ALT, 280 patients were divided into dominant group and non-dominant group. The data were analyzed by SSPSS22.0 software. The cumulative joint response rate was 8.6 in the first year of the total population, 13.2in the second year, 19.1in the third year, 24.2in the fourth year, 26.0in the fifth year. The combined response rate in the first 3 years was significantly higher than that in the non-dominant population, but there was no difference between the two groups after 3 years. The combined response occurred mainly in the first 3 years in the dominant population. Multivariate cox regression analysis showed that the co-response rate was higher in the dominant population. The occurrence of HBeAg serological transformation in the first year of the group is the only relevant factor for the occurrence of joint response. Hazard ratio [HR] 16.321P0. 000. After 3 years of nucleoside analogue therapy, The proportion of patients with baseline APRI score 鈮，

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