替比夫定治疗HBeAg阳性慢性乙型肝炎的临床研究

目的观察比较替比夫定与拉比夫定治疗HBeAg阳性慢性乙型肝炎的疗效。方法94例HBeAg阳性慢性乙型肝炎患者按就诊顺序分别纳入治疗组（47例）和对照组（47例）。治疗组每天口服替比夫定600mg，对照组每天口服拉米夫定100mg，疗程均为48周。治疗前和治疗后4、12、24、48周分别检测血清HBVDNA、血清HBV标志物及ALT水平。比较两组48周时HBVDNA水平、HBVDNA阴转率、HBeAg血清转换率、ALT复常率。结果两组HBVDNA水平随治疗时间的延长均有所下降，治疗4周时下降最明显。治疗48周时，治疗组HBVDNA阴转率（72．3％）高于对照组（42．6％）（Χ^2=8．530，P〈0．05）;ALT复常率、HBeAg阴转率及HBeAg血清转换率高于对照组，但差异均无统计学意义（均P〉0．05）。结论替比夫定可有效治疗HBeAg阳性慢性乙型肝炎，对血清指标的改善优于拉米夫定。

Clinical study of telbivudine on HBeAg-positive chronic hepatitis B

Objective To investigate the curative effect of telbivudine versus lamivudine in chronic hepatic B with a therapy of 48 weeks. Methods 94 patients who were diagnosed chronic hepatitis B were investigated. The therapeutic group and the control group (n = 47) were respectively assigned to receive 600mg of telbivudine and 100mg of lamivudine in 48 weeks. Copies of HBV-DNA、serum markers、alanine transarninase(ALT) level were tested before therapy and 4 weeks、12 weeks、24 weeks、48 weeks in the the course of treatment. The HBV-DNA conversion、HBeAg conversion and the normal rate of the ALT were compared. Results The copies of HBV-DNA decreased as the treatment progressing,especially at the 4 thweek. Conversion rate of the HBV-DNA of the telbivudine group was 72.3% ,which was higher than the lamivudine group 42.6%. There is a significant difference between two groups (x2 = 8.530,P ＜ 0.05). 95.7% of ALT in the telbivudine group revived to normal level versus 91.5% of the lamivudine group became normal. There is no significant difference between two groups (P ＞ 0.05). At the end of treatment,the rate of the HBeAg converting to negative in the telbivudine group is 38.3% versus the lamivudine group 31.9%, but there is no significant statistical difference between two groups(x2 = 0.420 ,P ＞ 0.05). The frequence of seroconversion of HBeAg in the telbivudine group is 23.4% versus the lamivudine group 17.0%, but no statisticall difference between two groups (x2 = 0. 594, P ＞ 0.05). Conclusion It was more effective to treat the HBeAg positive chronic hepatitis with telbivudine than lamivudine,and lower frequence of seroconversion of the HBV-DNA、HBeAg.