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替比夫定联合阿德福韦酯与PEG-IFN联合恩替卡韦治疗慢性乙型肝炎的效果比较
Efficacy of telbivudine combined with adefovir dipivoxil and pegylated interferon combined with entecavir as antiviral therapy for chronic hepatitis B: a comparative analysis
文章发布日期:2016年08月08日  来源:  作者:李 娜, 苟 卫, 崔伟丽  点击次数:1935次  下载次数:275次

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【摘要】:目的观察替比夫定联合阿德福韦酯与PEG-IFNα-2a联合恩替卡韦治疗HBeAg阳性的高病毒载量的慢性乙型肝炎患者的疗效差异。方法选取2012年11月-2015年11月在青岛市第六人民医院就诊的HBeAg阳性、高病毒载量的慢性乙型肝炎初治患者共80例,随机分成两组,每组40例。A组为替比夫定联合阿德福韦酯抗病毒组,B组为PEG-IFNα-2a联合恩替卡韦抗病毒组。观察两组患者分别服药12、24、48周时生化学、病毒学及血清学转换率有无差异。观察两组患者病毒耐药率及不良反应发生情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者在12、24、48周时病毒学、生化学应答率差异均无统计学意义(P值均>005)。12、24周时两组血清学转换率无明显差异,而48周时B组HBeAg阴转率及血清学转换率均高于A组且差异均有统计学意义(450% vs 675%,225% vs 450%,χ2值分别为4114 3、4.528 3,P值均<0.05)。B组患者出现的不良反应高于A组。结论PEG-IFNα-2a联合恩替卡韦和替比夫定联合阿德福韦酯均可有效抑制高载量HBV DNA的复制,延缓病情进展,实现HBeAg的血清学转换。但两种方案各有利弊,需根据临床实际情况加以选择。
【Abstract】:ObjectiveTo investigate the efficacy of telbivudine combined with adefovir dipivoxil and PEG-IFN-α-2a combined with entecavir as the antiviral therapy for HBeAg-positive patients with chronic hepatitis B (CHB) and a high viral load. MethodsA total of 80 previously untreated HBeAg-positive CHB patients with a high viral load who were treated in The Sixth People′s Hospital of Qingdao from November 2012 to November 2015 were enrolled and randomly divided into two groups. The patients in group A were treated with telbivudine combined with adefovir dipivoxil, and those in group B were treated with PEG-IFN-α-2a combined with entecavir. Biochemical and virologic response rates and seroconversion rate were observed at weeks 12, 24, and 48 of administration. The drug resistance rate and incidence rates of adverse events were observed in both groups. The Chi-square test was applied for comparision of categorical data between the two groups, and the t-test was applied for comparision of continuous data between the two groups. ResultsBiochemical and virologic response rates at weeks 12, 24, and 48 of administration showed no significant differences between the two groups. The seroconversion rates at weeks 12 and 24 of administration showed no significant differences between the two groups, while at week 48 of administration, group B had significantly higher HBeAg clearance rate and seroconversion rate than group A (450% vs 675%, 225% vs 450%,χ2=4.114 3 and 4.528 3, both P<0.05). Group B had significantly higher incidence rates of adverse events than group A. ConclusionTelbivudine combined with adefovir dipivoxil and PEG-IFN-α-2a combined with entecavir can effectively inhibit the replication of high-load HBV DNA, delay disease progression, and realize HBeAg seroconversion. However, the two regimens have their own advantages and disadvantages and should be selected according to clinical situation.
【关键字】:肝炎, 乙型, 慢性; 替比夫定; 阿德福韦酯; 干扰素类; 恩替卡韦
【Key words】:hepatitis B, chronic; telbivudine; adefovir dipivoxil; interferons; entecavir
【引证本文】:李娜, 苟卫, 崔伟丽. 替比夫定联合阿德福韦酯与PEG-IFN联合恩替卡韦治疗慢性乙型肝炎的效果比较[J]. 临床肝胆病杂志, 2016, 32(9): 1714-1716.

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