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1.
目的 评价恩替卡韦(ETV)对重庆地区拉米夫定治疗失效的慢性乙型肝炎(CHB)患者5年的疗效和安全性.方法 选取拉米夫定治疗失效的CHB患者32例,随机分为ETV组(剂量1.0 mg/d)28例和安慰剂组4例,完成12周的双盲治疗后,患者均接受开放的ETV(剂量1.0 mg/d)治疗,持续治疗至240周.分别检测治疗2、4、8、12、24、48、96、144、168、240周时患者的血清HBV DNA水平、HBsAg与HBeAg状态和肝功能情况.双盲阶段HBV DNA水平变化情况经Mauchly"球对称"检验后采用重复测量数据方差分析;连续性变量的统计描述用均数±标准差(x±s)表示.结果 在接受ETV治疗后,12周时ETV组患者血清HBV DNA水平平均下降4.05 log10拷贝/ml,安慰剂组平均下降0.08 log10拷贝/ml(P<0.05).治疗240周时,ETV组患者HBV DNA水平均值下降至2.58 log10拷贝/ml.HBV DNA<3 log10拷贝/ml患者的百分比在治疗前为0,从第8周开始上升(6.25%),24周时为15.6%,尤其在96周明显上升(50%),到240周末为57.14%.240周末有2例出现HBsAg血清学转换,4例出现HBeAg血清学转换.服用ETV后ALT水平下降较迅速,12周后均数达正常水平,且5年持续低于40 U/L.5年治疗期间,患者不良事件发生率为21%,有1例出现严重不良事件. 结论 ETV(1.0 mg/d)治疗拉米夫定失效的CHB患者具有显著的抗病毒和临床疗效,且安全性及耐受性良好.  相似文献   

2.
目的探讨恩替卡韦(ETV)联合六味五灵片治疗HBeAg阳性慢性乙型肝炎(CHB)患者的疗效。方法 102例HBeAg阳性CHB患者随机分为两组,联合治疗组50例每日服用ETV0.5mg,六味五灵片1.5g,每日3次;对照组52例每日服用ETV0.5mg。分别观察服药第12、24、52周时肝肾功能、血清HBeAg及HBV DNA水平。结果治疗52周结束时联合治疗组和对照组ALT复常率分别为88%和69.23%(P〈0.01);HBeAg/HBeAb血清学转换率分别为34%和25%(P〈0.05)。结论联合治疗组在ALT复常及HBeAg/HBeAb血清学转换方面均优于对照组,六味五灵片联合恩替卡韦可以起到很好的协同抗病毒的作用。  相似文献   

3.
目的 评价恩替卡韦(ETV)治疗慢性乙型肝炎(chronic hepatitis B,CHB)及乙型肝炎肝硬化的临床疗效.方法 将2009年10月-2012年3月我院接受ETV抗病毒治疗的CHB或乙型肝炎肝硬化患者73例分成3组,其中乙型肝炎肝硬化代偿期21例(A组),乙型肝炎肝硬化失代偿期18例(B组),CHB 34例(C组).治疗期间每12周检测患者HBV DNA和ALT水平,并采用FibroScan检测肝脏硬度,分析治疗前与治疗期间各指标的变化.分析行肝脏活体组织检查的19例的肝脏硬度值与病理诊断间的相关性.结果 ETV治疗第12、24、36、48周时,3组HBV DNA检测不到率(HBV DNA<40 IU/ml)和水平下降的中位数以及ALT复常率、FibroScan检测值改善情况相似.未发生药物相关不良反应.病理诊断结果与FibroScan检测值比较显示总符合率为57.9%.结论 ETV用于CHB或乙型肝炎肝硬化患者的抗病毒治疗,疗效确切,安全性好.FibroScan可通过动态监测肝脏硬度值变化,判定抗病毒治疗过程中肝纤维化程度的变化.  相似文献   

4.
目的评价瞬时弹性扫描(FibroScan)动态监测恩替卡韦(ETV)治疗慢性乙型肝炎(chronic hepatitis B,CHB)肝硬化过程中肝纤维化改善的作用。方法选择我院收治的CHB肝硬化患者352例,所有患者均接受ETV(初治患者或阿德福韦酯耐药患者0.5 mg/d,拉米夫定耐药患者1.0 mg/d)抗病毒治疗。进行定期随访,随访时间不短于3年。每3~6个月进行肝脏硬度测量(FibroScan)及生化学、病毒学指标检测,观察临床疗效。结果经过至少3年的抗病毒治疗,87.8%(309/352)的患者获得病毒学应答(HBV DNA40 IU/ml),基线及治疗3年时肝脏硬度值分别为30.8(17.3,46.4)kPa和18.6(12.0,27.9)kPa,差异有统计学意义(P=0.000)。9.7%(34/352)的患者由于各种原因发生病毒学突破(HBV DNA高于治疗过程中最低点1 log10IU/ml以上),其肝脏硬度值、ALT和TBIL均显著高于基线水平(P0.01)。结论 FibroScan在CHB肝硬化患者长期抗病毒过程中可动态监测肝纤维化的变化,FibroScan检测可作为肝脏活体组织检查可靠的替代方法。  相似文献   

5.
目的随机、对照、开放比较恩替卡韦(ETV)或阿德福韦酯(ADV)初治慢性乙型肝炎(CHB)患者2年的疗效。方法选取2007年8月-2007年12月在沈阳市第六人民医院住院的CHB患者60例,按1∶1的比例随机分成2组,分别接受ETV 0.5 mg/d或ADV 10 mg/d口服,疗程至少104周。评价患者96周HBV DNA下降幅度、HBV DNA阴转率、ALT复常率、HBeAg血清转换率、病毒学突破率及应答不佳率。结果 96周时,ETV组HBV DNA水平较基线平均降幅为(6.05±1.99)lg拷贝/ml,高于ADV组的(4.03±3.24)lg拷贝/ml(t=2.192,P=0.005)。ETV组HBV DNA阴转率高于ADV组(80%vs 40%,χ2=10.000,P=0.002)。ALT复常率、HBeAg阳性患者HBeAg血清转换率两组比较差异无统计学意义。ETV组无病毒学突破,应答不佳率为23.3%。ADV组病毒学突破率为13.3%,应答不佳率为73.3%(χ2=-2.053、15.017,P=0.04、<0.001)。结论 ETV相对于ADV可早期快速抑制病毒。不论是ETV还是ADV,24周评估原发性无应答及48周评估部分病毒学应答是优化治疗中应关注的截点。  相似文献   

6.
目的研究恩替卡韦对拉米夫定治疗失效的慢性乙型肝炎(CHB)患者的疗效和安全性.方法采用多中心、随机、双盲、安慰剂对照的临床试验,选择拉米夫定治疗失效的CHB病人145例,按4:1比例随机分为恩替卡韦组116例,安慰剂组29例.完成为期12周的治疗后,检测血清HBV DNA水平、HBeAg和肝生化功能的变化.结果恩替卡韦组在开始治疗后即有显著的抗病毒效果,直至治疗结束.用聚合酶链反应(PCR,Amplicor Cobas)定量法检测病人HBV DNA的平均下降幅度,恩替卡韦和安慰剂组分别为:4.30对数值(log10)和0.15对数值(log10),P值均<0.0001;在12周时,用bDNA方法检测,两组病人HBV DNA转阴率(<0.7 mEq/ml)为74%和10%.丙氨酸氨基转移酶(ALT)的复常率为71%和7%.两组不良事件的发生率相当(33%对28%).无1例发生药物相关的严重不良反应.结论用恩替卡韦治疗拉米夫定失效的病人12周,1.0 mg/d剂量在降低HBV DNA水平和ALT复常方面明显优于安慰剂,且安全性良好.  相似文献   

7.
目的探讨恩替卡韦(ETV)联合六味五灵片治疗乙型肝炎肝硬化的疗效。方法将122例乙型肝炎肝硬化患者随机分为对照组60例(口服ETV 0.5 mg/日)和治疗组62例(口服ETV 0.5 mg/日),同时给予六味五灵片1.5 g/次,每日3次口服,疗程均为24周。治疗结束后观察肝功能、HBV DNA低于检测下限的比率、HA、LN、PC-Ⅲ、CIV水平。结果 24周观察结束时治疗组的肝功能、HBV DNA低于检测下限的比率以及HA、LN、PC-Ⅲ、CIV指标下降情况均优于对照组,差异有统计学意义(P0.01)。结论 ETV联合六味五灵片治疗乙型肝炎肝硬化疗效显著,疗效优于单一用药组,是治疗乙型肝炎肝硬化的有效方法。  相似文献   

8.
目的比较ETV和ADV治疗核苷初治慢性乙型肝炎患者早期抗病毒疗效;通过12周治疗,探索治疗(ETV或ADV)起始时期HBV动力学应答情况;比较12周时达到HBV DNA临床显著性降低(<104copies/ml)的患者比例;与ADV比较,评价ETV的安全性。方法随机、开放、比较ETV 0.5mg/d,ADV 10mg/d的疗效。在给药的第1~14天、第3、4、6、8、10、12周时对血清HBV DNA进行检测。2个双相模型分别采用了2种治疗:①3-参数样条模型测评斜率;②4-参数指数式衰减模型测评疗效和游离病毒的半衰期。显著性评价依据双侧t检验。结果HBV DNA平均基线为10.45log10copies/ml(ETV)和9.89log10copies/ml(ADV),12周时HBV DNA平均改变值(log10copies/ml),ETV组患者(n=33)为:-6.23,而ADV组患者(n=32)仅为-4.42(P<0.0001)。所有ETV治疗的患者HBV DNA平均至少降低3.88log10copies/ml,ADV治疗的患者仅为0.95log10copies/ml。此外,与ETV相比,ADV治疗组不同患者之间病毒载量下降的差异性较大。治疗导致2组病毒载量出现双相下降,第一相下降迅速,持续10d。由此得出,循环的病毒半衰期为14h(ETV)和26h(ADV)。2个治疗组病毒下降的差异在第10天就体现出来,ETV治疗组病毒下降更低,2组间有显著差异。12周时,52%(17/33)ETV治疗患者HBV DNA低于10000 copies/ml,而ADV组为25%(8/32)。整个研究过程中,2种抗病毒药物耐受性均好,安全性相似。结论治疗HBeAg( )核苷初治患者,与ADV比较,ETV能迅速、强效降低HBV DNA,显示出更好的抗病毒活性。  相似文献   

9.
目的 探讨慢性乙型肝炎(CHB)抗病毒疗效与达到停药标准时外周血单个核细胞(PBMC)内HBV DNA水平的关系.方法 入选90例经抗病毒治疗达到停药标准的CHB患者,其中应用IFN 44例,应用核苷类药物46例.所有患者均于停药时检测PBMC内HBV DNA,比较阴性组和阳性组治疗前血清HBV DNA水平与达到停药标准时PBMC内HBV DNA的关系,观察停药时PBMC内HBV DNA水平与复发的关系.计量资料采用t检验,计数资料采用X2检验.结果 90例CHB患者停药时,PBMC内HBV DNA阴性组67例,阳性组23例.CHB患者血清HBV DNA阳转率在PBMC内HBV DNA阴性组为13.4%(9/67例),显著低于阳性组的73.9%(17/23例),差异有统计学意义(X2=30.4873,P<0.01).PBMC内HBV DNA阴性组与阳性组在肝病复发ALT升高幅度(t=0.8729,P=0.3913)、停药后复发时间(t=1.9222,P=0.0665)均差异无统计学意义,而在血清HBV DNA反弹幅度则差异有统计学意义(t=2.7493,P=0.0112).5例患者获得HBsAg血清学转换,且均未检测到PBMC内HBV DNA,随访6~12个月无一例复发.PBMC内HBV DNA阳性组治疗前血清HBV DNA水平为(7.2±1.1)lg拷贝/mL,显著高于阴性组的(5.2±2.1)lg拷贝/mL(t=4.3557,P<0.01).结论 经抗病毒治疗达到停药标准的CHB患者,其停药时的PBMC内HBV DNA水平可能是预测抗病毒疗效持久性的重要因素之一.
Abstract:
Objective To explore the relationship between the antiviral effect and peripheral blood mononuclear cell (PBMC) hepatitis B virus (HBV) DNA when the patients reach the standard of withdrawal of antiviral therapy in chronic hepatitis B (CHB).Methods Ninety CHB patients treated with interferon(n=44) or nucleot (s) ide(n=46) who reached the standard of withdrawal of antiviral therapy were recruited.HBV DNA levels in PBMCs were tested at the end of treatment,and its relationship with serum HBV DNA level before treatment in PBMC HBV DNA positive group and negative group were compared.The correlation between HBV DNA in PBMCs at the end of treatment and relapse were explored.Measurement data were analyzed by student t test and enumeration data were analyzed by X2 test.Results Among 90 patients,67(74.4%) were PBMC HBV DNA negative at the end of treatment,and 23(25.6%) were positive.The serum HBV DNA positive conversion rate in PBMC HBV DNA negative patients was 13.4%,which were significantly lower than that in positive group (73.9%) (X2=30. 4873, P<0.01 ). There were no significant differences of alanine aminotransferase (ALT) levels when hepatitis flare (t=0. 8729, P=0. 3913) and relapse time (t=1. 9222, P=0. 0665) between PBMC HBV DNA negative group and positive group after withdrawal of therapy, while the serum HBV DNA rebound was greater in positive group than that in negative group (t=2. 7493, P=0. 0112). There were five patients who achieved hepatitis B surface antigen (HBsAg) seroconversion, whose PBMC HBV DNA were all undetectable, and none relapsed during follow-up for 6-12 months. The pretreatment HBV DNA as level in PBMC HBV DNA positive was (7.2±1.1) lg copy/mL, which was much higher than that in negative group[(5.2±2.1) lg copy/mL] (t=4. 3557, P<0.01). Conclusions In patients who reach the standard of drug withdrawal,PBMC HBV DNA at the end of treatment is an important predictor for durability of antiviral therapy in CHB.  相似文献   

10.
Xing J  Han T  Liu L  Li Y  Li J  Li Y  Xiao SX 《中华肝脏病杂志》2011,19(11):828-832
目的 对拉米夫定(LAM)初治耐药后,LAM联合阿德福韦酯(ADV)应答不佳的慢性乙型肝炎患者,分别采用恩替卡韦(ETV)单药或ETV联合ADV进行补救治疗,比较两种补救方案的疗效.方法 对LAM初治耐药后应用LAM联合ADV应答不佳的40例患者,分别应用ETV 1.0 mg/d(14例)及ETV 0.5 mg/d联合ADV 10mg/d (26例)两种方案进行补救治疗,至少观察48周,定期监测HBV DNA、肝肾功能、HBV标志物等指标.根据资料不同分别采用t检验Wilcoxon检验或x2检验.结果 两组患者采用补救治疗前的基线情况差异无统计学意义.分别采用两种补救方案治疗后,两组患者HBV DNA水平均有下降,但ETV联合ADV组下降幅度较大.补救治疗24周时,ETV 1,0mg组有28.6%%(4例)达到HBV DNA转阴,ETV联合ADV组则有80.8% (21例)达到HBV DNA转阴,x2=8.469,P=0.004,差异具有统计学意义;48周时,ETV1.0mg组仍仅有4例患者HBV DNA转阴,而ETV联合ADV组全部26例患者均达到HBV DNA转阴.补救治疗24周时,ETV 1.0mg组有42.9%(6例)患者ALT复常,ETV联合ADV组有92.3% (24例)患者ALT复常,x 2=9.337,P=0.002,差异具有统计学意义;48周时,ETV 1.0mg组有57.1%(8例)患者ALT复常,而ETV联合ADV组所有患者均达到ALT复常.补救治疗48周时,ETV 1.0mg组有1例患者发生HBeAg血清学转换,ETV联合ADV组有4例患者发生HBeAg血清学转换.结论 对于LAM耐药后LAM联合ADV应答不佳的慢性乙型肝炎患者,采用ETV联合ADV的补救方案较ETV单药1.0mg的方案更为有效,可以实现更好的病毒学及生物化学应答.  相似文献   

11.
Entecavir is an oral antiviral drug with selective activity against hepatitis B virus (HBV). We conducted a randomized, placebo-controlled, dose-escalating study in patients with chronic hepatitis B infection in which we evaluated the efficacy and safety of entecavir given for 28 days. Follow-up was 24 weeks. All doses of entecavir (0.05 mg, 0.1 mg, 0.5 mg, and 1.0 mg) showed a pronounced suppression of replication of the HBV with a 2.21, 2.29, 2.81, and 2.55 mean log(10) reduction of viral load, respectively. Approximately 25% of patients on entecavir showed a decline of HBV DNA below the limit of detection of the Chiron HBV-DNA assay (<0.7 MEq/mL). In the postdosing follow-up period patients who were treated with 0.5 and 1.0 mg of entecavir showed a considerably slower return in their HBV DNA levels to baseline compared with those patients treated with lower dosages (P <.05). All doses of entecavir were well tolerated with no significant difference between treated patients and those receiving placebo. No significant changes in alanine transaminase (ALT) levels within the dose groups and the placebo group between baseline and the end of treatment were observed. Three patients (9%) (1 each in the 0.05-, 0.1-, and 0.5-mg groups) experienced asymptomatic hepatitis flares 16 weeks (2 patients) and 24 weeks (1 patient) after withdrawal of entecavir. In conclusion, in this 28-day study of entecavir a pronounced decrease of HBV DNA was observed and there were no significant side effects in entecavir patients in comparison with placebo-treated patients.  相似文献   

12.
BACKGROUND & AIMS: Entecavir is a novel and selective nucleoside analogue with potent activity against hepatitis B virus (HBV). METHODS: In a 24-week, double-blind, randomized, multicenter, phase II clinical trial, the safety and efficacy of entecavir (0.01 mg/day, 0.1 mg/day, or 0.5 mg/day orally) were compared with lamivudine (100 mg/day orally). Patients (n = 169) chronically infected with HBV (hepatitis B e antigen [HBeAg]-positive and -negative) were evaluated for efficacy. RESULTS: Compared with lamivudine, entecavir reduced HBV DNA by an additional 0.97 log(10) at the 0.1-mg/day dose and an additional 1.28 log(10) at the 0.5-mg/day dose (P < 0.0001). A clear dose-response relationship was observed for entecavir with the higher doses showing significantly greater viral suppression. In patients treated with entecavir 0.5 mg/day, 83.7% had an HBV-DNA level below the lower limit of detection of the Quantiplex branched DNA (bDNA) assay (Bayer-Versant Diagnostics, formerly Chiron Diagnostics, Emeryville, CA), compared with 57.5% treated with 100 mg/day lamivudine (P = 0.008). In both treatment arms, very few patients achieved HBeAg loss and/or seroconversion by week 22. More patients treated with the 0.1-mg/day and 0.5-mg/day doses of entecavir had normalization of alanine transaminase (ALT) levels at week 22 compared with lamivudine (P = not significant). Entecavir was well tolerated; most adverse events were mild to moderate, transient, and comparable in all study arms. CONCLUSIONS: This study showed that entecavir has potent antiviral activity against HBV at 0.1-mg/day and 0.5-mg/day doses, both of which were superior to lamivudine in chronically infected HBV patients.  相似文献   

13.
Background and Aim:  Entecavir has demonstrated clinical efficacy for chronic hepatitis B. This study evaluated the efficacy and safety of entecavir in nucleoside-naive Japanese chronic hepatitis B patients.
Methods:  In this multicenter, double-blind study, 66 nucleoside-naive Japanese chronic hepatitis B patients were randomized to 0.1 mg entecavir ( n  = 32) or 0.5 mg entecavir ( n  = 34) daily for 52 weeks. The primary endpoint was the proportion of patients whose serum hepatitis B virus (HBV) DNA decreased from baseline by ≥2 log10 copies/mL or became undetectable (<400 copies/mL by polymerase chain reaction assay) at week 48.
Results:  One hundred percent of patients in both treatment groups achieved the primary efficacy endpoint, with 81% and 68% of patients achieving undetectable HBV DNA in the 0.1 mg and 0.5 mg treatment groups, respectively. Mean changes from baseline in HBV DNA were −4.49 log10 and −4.84 log10 copies/mL for the 0.1 mg and 0.5 mg groups, respectively. Significant improvements in necroinflammation were seen in both groups, as assessed by Knodell and New Inuyama classifications. Most adverse events were transient and classified as grade 1 or 2. There were no clinically significant differences in adverse events across the two treatment groups and no discontinuations due to adverse events in either group.
Conclusions:  In Japanese nucleoside-naive patients with chronic hepatitis B, 0.1 mg or 0.5 mg entecavir daily provided excellent efficacy and was well tolerated. The 0.5 mg dose was selected for the treatment of nucleoside-naive patients.  相似文献   

14.
Purpose  A randomized, double-blind, multicenter study (ETV-047) was conducted to evaluate the dose–response relationship of entecavir and compare its antiviral activity and safety with lamivudine in Japanese patients with chronic hepatitis B (CHB). Methods  One hundred thirty-seven nucleoside-naive adult patients with CHB were randomized to once-daily oral doses of entecavir 0.01, 0.1, or 0.5 mg or lamivudine 100 mg for 24 weeks. The primary efficacy end point used to evaluate the dose–response relationship was mean change from baseline in serum hepatitis B virus (HBV) DNA level at week 22, as determined by polymerase chain reaction assay. Results  Entecavir demonstrated a clear dose–response relationship, with mean change from baseline in serum HBV DNA level of −3.11, −4.77, and −5.16 log10 copies/ml with entecavir 0.01, 0.1, and 0.5 mg, respectively. Entecavir 0.5 mg was superior to lamivudine 100 mg for the mean change in HBV DNA level (−5.16 vs. −4.29 log10 copies/ml; P = 0.007). The overall incidence of adverse events was comparable between treatment groups. Two patients discontinued treatment because of adverse events (one with liver cirrhosis [entecavir 0.5 mg] and one with grade 4 serum alanine aminotransferase (ALT) elevation, nausea, and malaise [lamivudine 100 mg]). Serum ALT flares were observed in four patients; flares were associated with 2 log10 reductions or more in HBV DNA level and resolved without dose interruption. Conclusion  Entecavir 0.01–0.5 mg is well tolerated and produces a dose-dependent reduction in viral load in nucleoside-naive Japanese patients with CHB. Compared with lamivudine 100 mg, entecavir 0.1 mg demonstrated noninferiority and entecavir 0.5 mg was superior in this population.  相似文献   

15.
目的观察恩替卡韦治疗失代偿期乙型肝炎肝硬化患者48周时的疗效。方法肝硬化患者随机分为两组,分别给予口服恩替卡韦0.5mg/d和拉米夫定100mg/d。观察24、48周时肝功能、凝血酶原活动度(PTA)、血清学、病毒学、肝纤维化指标、Child-Pugh积分等变化情况。结果 24周时肝功能、PTA、肝纤维化指标和Child-Pugh积分等均有所改善,但两组间差异无统计学意义(P〉0.05),随着疗程的延长无明显变化。恩替卡韦组在24、48周时分别有26.1%(6/23)及30.4%(7/23)的患者出现HBeAg血清学转换,但两组间差异无统计学意义(P〉0.05)。24、48周HBV DNA水平下降值、HBV DNA阴转率恩替卡韦组高于拉米夫定组(P〈0.05)。结论恩替卡韦能有效、快速抑制失代偿期乙型肝炎肝硬化患者的病毒复制,改善肝功能。  相似文献   

16.
BACKGROUND & AIMS: Entecavir is a nucleoside analogue with potent in vitro activity against lamivudine-resistant hepatitis B virus (HBV). This randomized, dose-ranging, phase 2 study compared the efficacy and safety of entecavir with lamivudine in lamivudine-refractory patients. METHODS: Hepatitis B e antigen (HBeAg)-positive and -negative patients (n = 182), viremic despite lamivudine treatment for > or =24 weeks or having documented lamivudine resistance substitutions, were switched directly to entecavir (1.0, 0.5, or 0.1 mg daily) or continued on lamivudine (100 mg daily) for up to 76 weeks. RESULTS: At week 24, significantly more patients receiving entecavir 1.0 mg (79%) or 0.5 mg (51%) had undetectable HBV DNA levels by branched chain DNA assay compared with lamivudine (13%; P < .0001). Entecavir 1.0 mg was superior to entecavir 0.5 mg for this end point (P < .01). After 48 weeks, mean reductions in HBV DNA levels were 5.06, 4.46, and 2.85 log(10) copies/mL on entecavir 1.0, 0.5, and 0.1 mg, respectively, significantly higher than 1.37 log(10) copies/mL on lamivudine. Significantly higher proportions of patients achieved normalization of alanine aminotransferase levels on entecavir 1.0, 0.5, and 0.1 mg (68%, 59%, and 47%, respectively) than on lamivudine (6%). One virologic rebound due to resistance occurred (in the 0.5-mg group). CONCLUSIONS: In HBeAg-positive and HBeAg-negative lamivudine-refractory patients, treatment with entecavir 1.0 and 0.5 mg daily was well tolerated and resulted in significant reductions in HBV DNA levels and normalization of alanine aminotransferase levels. One milligram of entecavir was more effective than 0.5 mg in this population.  相似文献   

17.
目的探讨恩替卡韦治疗慢加急性乙型肝炎肝衰竭近期疗效。方法 68例慢加急性乙型肝炎肝衰竭患者被分成治疗组(42例)和对照组(26例),对照组采用常规内科治疗,治疗组在常规内科治疗基础上加用恩替卡韦0.5mg/d,比较两组治疗后血生化指标、凝血酶原活动度、HBV DNA水平、MELD分值变化及病死率。结果在治疗后12周,治疗组总胆红素和HBV DNA分别为89.7±42.5μmol/L和3.16±2.04log10copies/mL,显著低于对照组患者(145.6±64.2μmol/L和6.28±3.95log10copies/mL,P<0.01),凝血酶原活动度和白蛋白分别为48.5±15.6%和34.8±4.8g/L,显著高于对照组(40.5±12.4%和30.2±4.1g/L,P<0.05或P<0.01);治疗组早中期患者MELD分值和病死率分别为17.6±3.5和20.0%,显著低于对照组(22.4±4.1和52.9%,P<0.05或P<0.01),两组晚期患者MELD分值和病死率差异无统计学意义(P>0.05);治疗组有1例HBeAg阴转,1例HBeAg血清学转换,对照组HBVM无变化。结论恩替卡韦能有效抑制HBV复制,改善慢加急性乙型肝炎肝衰竭患者肝功能,降低早中期患者MELD分值和病死率。尽早抗病毒治疗可提高慢加急性乙型肝炎肝衰竭患者的生存率。  相似文献   

18.
目的评价核苷(酸)类似物治疗乙型肝炎(乙肝)病毒相关性。肾炎(hepatitis B virus—associated glomerulonephritis,HBV—GN)合并慢性乙肝或肝硬化的临床疗效和安全性。方法选择病理诊断为HBV—GN,同时合并慢性乙肝或肝硬化的患者共36例。患者分成2组:核苷(酸)类似物抗病毒治疗组25例,给予拉米夫定0.1g,1次/d,或恩替卡韦0.5mg,1次,d,空腹口服;对照组11例,未给予核苷(酸)类似物抗病毒治疗。2组均给予常规保肝降酶及保护肾功能的治疗。观察治疗前后临床指标变化,包括用药期间尿蛋白排泄情况、肝。肾功能和乙肝病毒学指标以及不良反应。结果治疗12个月时,抗病毒治疗组24h尿蛋白定量较治疗前明显减少,血清ALB较治疗前明显升高;对照组24h尿蛋白定量和ALB与治疗前相比无显著改善。2组ALT和AST水平治疗后均明显改善,但抗病毒治疗组ALT和AST下降幅度明显大于对照组。抗病毒治疗组血清HBVDNA水平治疗后明显下降,对照组治疗前后无明显变化。抗病毒治疗组治疗12个月时的完全缓解率、总有效率明显高于对照组。结论核苷(酸)类似物治疗HBV—GN,可显著降低尿蛋白,使ALB升高,HBVDNA水平降低,缓解肾病综合征的临床症状,取得满意疗效,且耐受性好,未见明显不良反应。  相似文献   

19.
替比夫定与恩替卡韦治疗慢加急性肝衰竭的疗效分析   总被引:1,自引:1,他引:0  
目的观察替比夫定和恩替卡韦治疗慢加急性肝衰竭临床疗效。方法选择57例乙型肝炎慢加急性肝衰竭患者,替比夫定组28例,使用替比夫定600 mg/d;恩替卡韦组29例,使用恩替卡韦0.5 mg/d。观察指标为肝功能、凝血酶原时间(PT)、HBV DNA,分别于治疗后2、4、6、8、12周取值,因为生存率的问题,肝功能、PT只取2、4、6周进行对比。结果替比夫定组和恩替卡韦组病死率分别为21.43%、48.28%,差异有统计学意义;两组HBV DNA阴转率及时限上相比均不具有统计学意义。两组治疗后PT、胆碱酯酶、TBil、血清白蛋白(Alb)随着治疗时间的延长,均改善,但在治疗后第2、4、6周相同时间点时比较,差异均有统计学意义(P〈0.01),替比夫定组改善较恩替卡韦组改善提前。结论替比夫定治疗慢加急性肝衰竭,能有效降低病死率  相似文献   

20.
恩替卡韦治疗慢性乙型重型肝炎的近期疗效观察   总被引:3,自引:1,他引:2  
目的评价恩替卡韦治疗慢性乙型重型肝炎的近期临床疗效。方法57例患者在常规治疗的基础上给予恩替卡韦0.5mg,每日1次口服;另86例给予拉米夫定100mg,每日1次口服,存活患者的治疗时间不少于6个月。结果接受恩替卡韦治疗后6个月时,总胆红素和谷丙转氨酶分别由治疗前的270.1±81.8μmol/L和342.5±130.7U/L降至74.9±36.5μmol/L和71.24±2.8U/L,均较拉米夫定组改善更明显(P〈0.05);恩替卡韦组的HBVDNA转阴率为69.8%,明显高于拉米夫定组的46.8%(P〈0.05)。病死率分别为7.0%和10.5%,无显著性差异(P〉0.05)。结论恩替卡韦治疗慢性乙型重型肝炎患者在近期临床疗效、肝功能改善和抑制病毒复制方面均优于拉米夫定治疗者。  相似文献   

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