本文選題：恩替卡韋 + 慢性乙型肝炎�。� 參考：《石河子大學》2017年碩士論文

【摘要】：背景:恩替卡韋對HBV抗病毒治療療效的研究是核苷類似物抗病毒治療的重要內容,臨床上已經(jīng)注意到恩替卡韋對慢性乙型病毒性肝炎(CHB)不同臨床時期的抗病毒治療療效差異,而B、C基因型的CHB不同臨床時期是否影響恩替卡韋對CHB的抗病毒療效,目前報道較少,明確恩替卡韋對B、C基因型CHB患者之間的臨床療效差異,指導恩替卡韋對B、C基因型乙肝患者的臨床用藥,爭取最大限度的長期抑制HBV復制,減輕肝細胞炎癥壞死,從而改善患者的生活質量并延長其生存時間。特別是在其他藥物抗病毒療效欠佳、耐藥率高且患者依從性差的情況下,通過恩替卡韋對B、C基因型CHB患者之間的臨床療效差異性觀察,對促進臨床乙肝病毒治療提供理論支持具有重要意義。目的:分析恩替卡韋對B、C基因型CHB患者之間的抗病毒治療療效并比較差異性。方法:對我院符合標準的初始抗病毒治療的慢性乙型病毒性肝炎肝炎期、肝硬化代償期及肝硬化失代償期患者住院資料進行回顧性分析。根據(jù)納入標準及排除標準納入,分別觀察CHB患者在經(jīng)恩替卡韋治療4、12、24及48周時,HBVDNA載量、HBsAg定量、TBIL定量、ALB定量及ALT水平。治療結束后觀察HBeAg血清學轉換情況及肝硬化失代償期中腹水,消化道出血及肝性腦病的再發(fā)情況。結果:共納入初始抗病毒治療的B基因型CHB患者60例、C基因型CHB患者100例,(1)性別分布,男性119人,占病例總數(shù)的74.37%(119/160),女性41人,占病例總數(shù)的25.63%(41/160)。男女比例2.9:1,男性感染HBV的幾率明顯高于女性2倍以上。(2)年齡分布,30-50歲的患者比例最高,占病例總數(shù)的63.75%(102/160)。(3)CHB患者治療基線時水平:160例B、C基因型CHB患者治療前HBVDNA載量、HBsAg定量及ALT水平比較差異無統(tǒng)計學意義(P0.05)。但肝炎期、肝硬化代償期與肝硬化失代償期患者相比,血清總膽紅素(TBIL)、血清白蛋白水平(ALB)差異有統(tǒng)計學意義(P0.05)。(4)160例CHB患者治療后HBVDNA載量及ALT水平較基線時均有明顯下降,治療結束時HBVDNA陰轉率81.25%,ALT復常率78.75%,但B、C基因型兩組患者HBVDNA載量變化及ALT復常率差異無統(tǒng)計學意義。(5)肝炎期及肝硬化代償期與肝硬化失代償期患者相比,在治療4、12、24及48周時,HBVDNA陰轉率及ALT陰轉率差異均具有統(tǒng)計學意義(P0.05),HBsAg陰轉率無統(tǒng)計學差異(P0.05)。(6)B基因型CHB患者肝硬化失代償期經(jīng)恩替卡韋治療48周后療效顯著,至治療結束時,肝硬化失代償期并腹水患者、肝硬化失代償期并出血患者及肝硬化失代償期并肝性腦病患者均較基線時好轉,差異具有統(tǒng)計學意義(P0.05),同樣,C基因型CHB患者肝硬化失代償期經(jīng)恩替卡韋治療48周后療效與基線時相比也得到相似結果,但相同時期的B、C兩基因型患者之間相比,無統(tǒng)計學差異(P0.05)。(7)相同時期的B、C基因型之間相比,HBVDNA陰轉率、ALT陰轉率ALB復常率、TBIL復常率及HBsAg陰轉率均無統(tǒng)計學差異(P0.05)。結論:1.恩替卡韋抗病毒治療療效與B、C基因型無關。
[Abstract]:Background: entecavir's antiviral treatment for HBV is an important part of the antiviral therapy of nucleoside analogues. It has been noted that entecavir has different therapeutic effects on the antiviral treatment of chronic hepatitis B (CHB) in different clinical periods, and whether B, C genotype CHB affects the resistance of entecavir to CHB The efficacy of the virus is less reported. The clinical effect of entecavir on B and C genotype CHB patients is clearly defined. It guides the clinical use of entecavir for B and C genotype hepatitis B patients, strives for the maximum long-term inhibition of HBV replication and alleviating inflammatory necrosis of the liver cells, improving the quality of life and prolonging the survival time of the patients. It is of great significance to provide theoretical support for the promotion of clinical hepatitis B virus therapy through the observation of the clinical efficacy of entecavir on B and C genotype CHB in the case of poor antiviral effect, high drug resistance and poor compliance. Methods: a retrospective analysis was made to the data of patients with chronic hepatitis B, liver cirrhosis and decompensated cirrhosis in our hospital, which accords with the standard initial antiviral treatment. According to the inclusion criteria and exclusion criteria, the patients with CHB were treated with entecavir to treat 4,12,2 respectively. 4 and 48 weeks, HBVDNA load, HBsAg quantitative, TBIL quantitative, ALB quantitative and ALT level. After the treatment, the serological conversion of HBeAg and the recurrence of ascites, digestive tract hemorrhage and hepatic encephalopathy were observed. Results: 60 cases of B based CHB patients were included in the initial antiviral treatment, 100 cases of C genotype CHB patients, and (1) sex. The distribution, 119 men, accounted for 74.37% (119/160) of the total cases, 41 women, 25.63% (41/160) of the total cases. The ratio of men and women was 2.9:1, the rate of male infection of HBV was significantly higher than that of women. (2) age distribution, the proportion of 30-50 year old patients was the highest, accounting for 63.75% (102/160). (3) CHB patients at the baseline level: 160 B, C gene. There was no significant difference in the HBVDNA load, HBsAg quantitative and ALT levels before treatment for patients with CHB (P0.05). However, the serum total bilirubin (TBIL) and serum albumin level (ALB) were statistically significant (P0.05) compared with the patients with decompensated cirrhosis (P0.05). (4) the HBVDNA load and ALT level after treatment in 160 cases of CHB patients. The HBVDNA negative rate was 81.25% and the ALT recurrence rate was 78.75% at the end of the treatment, but there was no significant difference in the HBVDNA load and the ALT recurrence rate in the two groups of B and C genotypes. (5) the rate of HBVDNA negative and ALT negative in the 4,12,24 and 48 weeks after the treatment of liver cirrhosis and the decompensation period of liver cirrhosis. The difference in rate of rate was statistically significant (P0.05), and there was no statistical difference in the negative rate of HBsAg (P0.05). (6) the effect of the decompensation period of the B genotype CHB patients was significant after 48 weeks of entecavir treatment, and at the end of the treatment, the decompensated cirrhosis and ascites, the decompensated cirrhosis and the liver cirrhosis and hepatic encephalopathy at the end of the treatment. The patients were all better than the baseline (P0.05). Similarly, the curative effect of C genotype CHB patients after 48 weeks of entecavir treatment was similar to that of baseline, but there was no statistical difference between B and C two genotypes at the same time (P0.05). (7) the B, C genotypes at the same time. Compared with HBVDNA negative conversion rate, ALT negative rate ALB repetition rate, TBIL repetition rate and HBsAg negative rate, there was no statistical difference (P0.05). Conclusion: 1. the antiviral effect of entecavir is not related to B, C genotype.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62

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