【摘要】：目的對干擾素單藥治療24周應(yīng)答不佳的HBe Ag陽性慢性乙型肝炎(CHB)患者采用不同的治療方案進行后續(xù)治療,分析比較其療效和安全性。方法回顧性分析2010年9月~2013年1月南方醫(yī)科大學(xué)南方醫(yī)院193例干擾素治療24周時應(yīng)答不佳的HBe Ag陽性的CHB患者,根據(jù)不同后續(xù)治療方案分成:聯(lián)用恩替卡韋(ETV)或阿德福韋(ADV)治療(A組),繼續(xù)干擾素單藥治療(B組),換為NAs治療(C組),直接停止治療(D組)。觀察比較第24、48、72周時各組患者的臨床療效與安全性。結(jié)果繼續(xù)治療至療程48周時,A組和C組HBV DNA轉(zhuǎn)陰率、ALT復(fù)常率均高于B組(A組:χ2=26.808,P0.001和χ2=5.485,P=0.017;C組:χ2=21.257,P0.001和χ2=5.369,P=0.018);同時發(fā)現(xiàn),加ETV組HBV DNA轉(zhuǎn)陰率高于加ADV組(χ2=8.255,P=0.004)。療程72周時,A組患者有27例(39.7%)發(fā)生HBe Ag血清學(xué)轉(zhuǎn)換,明顯高于B、C兩組(χ2=4.238,P=0.04和χ2=7.681,P=0.006);58例(85.3%)獲得HBV DNA轉(zhuǎn)陰,59例(86.8%)ALT恢復(fù)正常,均高于B組(χ2=23.018,P0.001和χ2=5.987,P=0.014),但與C組比較差異無統(tǒng)計學(xué)意義(P0.05);同時發(fā)現(xiàn),聯(lián)合ETV組HBV DNA轉(zhuǎn)陰率和HBe Ag血清學(xué)轉(zhuǎn)換率均高于加ADV組(χ2=9.823,P=0.002和χ2=5.450,P=0.020)。D組,28例患者的HBV DNA均持續(xù)較高水平復(fù)制,HBe Ag水平升高,ALT反復(fù)波動。結(jié)論對于干擾素單藥治療24周時應(yīng)答不佳的CHB患者,聯(lián)用NAs并延長療程可明顯提高HBe Ag血清學(xué)轉(zhuǎn)換率、HBV DNA轉(zhuǎn)陰率及ALT復(fù)常率,特別是聯(lián)用ETV并延長療程時。
[Abstract]:Objective to evaluate the efficacy and safety of interferon alone in the treatment of HBe Ag positive patients with chronic hepatitis B (CHB) in 24 weeks. Methods from September 2010 to January 2013, 193 patients with HBe Ag positive CHB who were treated with interferon at the Southern Hospital of Southern Medical University were analyzed retrospectively. The patients were divided into two groups according to the following treatment: group A treated with entecavir (ETV) or adefovir (ADV) (group A), group B treated with interferon alone (group B), treated with NAs (group C), and treated with direct cessation of treatment (group D). To observe and compare the clinical efficacy and safety of each group at week 24, 48 and 72. Results after 48 weeks of treatment, the negative conversion rate of HBV DNA in group A and group C was significantly higher than that in group B (group A: 蠂 2 + 26.808) P0.001 and group C (蠂 25.485): P 0.001 and 蠂 ~ (2 +) 5.369P0.018, and the negative conversion rate of HBV DNA in ETV group was higher than that in group B (蠂 ~ (2) 8.255P _ (0.004). HBe Ag seroconversion occurred in 27 patients (39.7%) in group A at 72 weeks of treatment, which was significantly higher than that in group C (蠂 2 + 4.238%, P 0.04 and 蠂 2 (7.681) P 0. 006). 59 cases (86.8%) of HBV DNA turned negative to normal, which were higher than those in group B (蠂 2 + 23.018 P 0.001 and 蠂 2 5.98 7 P 0. 014), but there was no significant difference between group C and group C (P0.05), and it was found that there was no significant difference between group C and group C (P 0.05), and the positive rate of ALT in group A was significantly higher than that in group B (P < 0.05), but there was no significant difference between group C and group C (P 0.05). The negative rate of HBV DNA and the serological conversion rate of HBe Ag in the combined ETV group were higher than those in the + ADV group (蠂 2 + 9. 823 P0. 002 and 蠂 2 + 5. 450 P + 0. 020). The HBV DNA levels of the 28 patients with ETV were significantly higher than those of the control group (蠂 2 + 9. 823 P0. 002 and 蠂 2 + 5. 450 P + 0. 020). Conclusion for patients with CHB who have a poor response at 24 weeks after treatment with interferon alone, the serological conversion rate of HBe Ag and the return rate of ALT in combination with NAs and prolongation of the course of treatment can be significantly increased, especially when combined with ETV and prolonging the course of treatment.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院感染內(nèi)科//國家器官衰竭研究重點實驗室//廣東省病毒性肝炎研究重點實驗室;
【基金】：國家自然科學(xué)基金(81470856) 中國肝炎防治基金會課題(XJS20120601)~~
【分類號】：R512.62

【參考文獻】

相關(guān)期刊論文 前1條

1 吳發(fā)玲;丁洋;竇曉光;;聚乙二醇干擾素α-2a聯(lián)合阿德福韋酯治療慢性乙型肝炎的Meta分析[J];實用藥物與臨床;2012年01期

【共引文獻】

相關(guān)期刊論文 前10條

1 魏婷婷;胡海峰;;幾種基因工程藥物的研究現(xiàn)狀[J];世界臨床藥物;2013年09期

2 姚偉明;徐東平;;抗HBV藥物靶位的研究進展[J];傳染病信息;2013年06期

3 ;Chinese Consensus on Antiviral Treatment of Chronic Hepatits B Patients with Nucleos(t)ide Analogues[J];Infection International(Electronic Edition);2013年02期

4 黃睿;郝迎迎;張俊;吳超;;拉米夫定聯(lián)合阿德福韋酯與恩替卡韋單藥對慢性乙型肝炎初治患者療效比較的Meta分析[J];重慶醫(yī)學(xué);2014年01期

5 科技部十二五重大專項聯(lián)合課題組專家;;乙型肝炎病毒相關(guān)肝硬化的臨床診斷、評估和抗病毒治療的綜合管理[J];實用肝臟病雜志;2014年02期

6 袁婧;張長江;朱研;王小紅;;核苷(酸)類似物治療乙型肝炎病毒相關(guān)肝病患者停藥復(fù)發(fā)的臨床轉(zhuǎn)歸及影響因素[J];第三軍醫(yī)大學(xué)學(xué)報;2014年08期

7 劉穎;樊蓉;陳簡;鄭志丹;廖寶林;梁攜兒;尹軍花;周秋根;孫劍;;慢性乙型肝炎病毒感染相關(guān)肝硬化患者的腎功能及危險因素分析[J];南方醫(yī)科大學(xué)學(xué)報;2014年04期

8 何文艷;安紅杰;徐金鳳;;恩替卡韋治療失代償期乙型肝炎肝硬化1例[J];中國肝臟病雜志(電子版);2014年01期

9 邢卉春;楊松;程丹穎;李s，

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