替诺福韦酯与恩替卡韦对慢性乙型肝炎初治疗患者的疗效

目的评估替诺福韦酯与恩替卡韦在治疗慢性乙型肝炎的疗效。 方法纳入2010年6月至2015年6月入住济南军区总医院的慢性乙型肝炎的初治患者100例，采用随机数字表法分为观察组(替诺福韦酯)50例、对照组(恩替卡韦)50例，随访时间12、24个月，比较二者在HBV-DNA转阴率、HBeAg血清学转换率、丙氨酸转氨酶复常率、耐药率、安全性方面是否存在差异。 结果与治疗前比较，观察组与对照组在随访观察12、24个月后各项指标较前明显改善，但二者在HBV-DNA转阴率(32/50 vs.28/50、46/50 vs.42/50)、HBeAg血清学转换率(4/28 vs.6/30、8/28 vs.12/30)、丙氨酸转氨酶复常率(42/50 vs.40/50、49/50 vs.46/50)、耐药率方面未见明显差异；但长期口服恩替卡韦对肾脏影响高于替诺福韦酯组，差异有统计学意义(P<0.05)。 结论替诺福韦酯与恩替卡韦比较，二者在治疗慢性乙型肝炎效果相当，但长期口服药物安全性方面有优势，因此建议长期治疗慢性乙型肝炎临床运用替诺福韦酯作为首选方案。

Efficacy of tenofovir and entecavir in initial treatment of chronic hepatitis B patients

ObjectiveTo evaluate the efficacy of tenofovir(TDF)and entecavir(ETV)for the patients with chronic hepatitis B. MethodsA total of 100 patients with chronic hepatitis B were included in the trial from June 2010 to June 2015 in Jinan Military General Hospital.All patients were divided into observation group(TDF)and control group(ETV)using random number table method, 50 patients in each group.The rates of hepatitis B virus(HBV)DNA suppression, hepatitis B virus e antigen(HBeAg)seroconversion, alanine transaminase(ALT)normalization, resistance and drug safety of the two groups were compared at 12, 24 months. ResultsAt 12, 24 months, the various indexes of the two groups improved obviously.Compared with the ETV, TDF has the similarity in efficacy in the HBV DNA suppression(32/50 vs.28/50, 46/50 vs.42/50), HBeAg seroconversion(4/28 vs.6/30, 8/28 vs.12/30), ALT normalization(42/50 vs.40/50, 49/50 vs.46/50)and drug resistance rate.But the oral TDF was more safety with the longer administration in renal function compared with ETV. ConclusionTDF is very effective in the treatment of chronic hepatitis B which compared with ETV, but probably has more safety in the long-term administration, so we recommend the TDF as the primary drug in the long-term treatment of chronic hepatitis B.