血府逐瘀胶囊联合恩替卡韦治疗乙型肝炎肝硬化代偿期的疗效观察

目的 观察血府逐瘀胶囊联合恩替卡韦治疗乙型肝炎肝硬化代偿期的临床疗效.方法 将60例乙型肝炎肝硬化代偿期患者分为观察组和对照组各30例,观察组口服血府逐瘀胶囊联合恩替卡韦治疗,对照组仅服用恩替卡韦抗病毒治疗,疗程均为1年.观察2组患者治疗前后肝功能、HBV DNA转阴率、脾长径、血常规等指标的变化,记录不良反应.结果 观察组在肝功能改善、脾肿大回缩、白细胞及血小板回升方面效果优于对照组,差异有统计学意义（P＜0.05）;在病毒学方面,对照组HBV DNA转阴率为83.3％ （25/30）,观察组则为90％ （27/30）,差异无统计学意义（P＞0.05）;两组治疗期间以及治疗后均未发现明显不良反应.结论 与单纯恩替卡韦治疗相比,血府逐瘀胶囊联合恩替卡韦治疗乙型肝炎肝硬化代偿期,在改善肝功能、血常规、脾功能亢进方面均有良好疗效.     

替比夫定和恩替卡韦治疗代偿期乙型肝炎肝硬化的临床疗效分析

目的分析替比夫定和恩替卡韦治疗代偿期乙型肝炎肝硬化的临床疗效。方法选取2013年8月至2014年8月本院收治的代偿期乙型肝炎肝硬化患者60例,按照不同给药方法分为观察组与对照组,每组30例。对照组患者恩替卡韦治疗,观察组患者替比夫定治疗,记录并分析相关数据。结果两组治疗48周后肝功能和肝纤维化水平均低于治疗前,差异均具统计学意义(P<0.05)。结论替比夫定和恩替卡韦治疗代偿期乙型肝炎肝硬化的临床疗效相当。     

恩替卡韦治疗代偿期肝硬化的疗效观察

目的 观察恩替卡韦分散片治疗代偿期乙型肝炎肝硬化的疗效与安全性.方法 60例乙型肝炎肝硬化代偿期患者接受恩替卡韦分散片治疗72周,观察治疗前后肝肾功能、病毒学指标等的变化情况,动态监测治疗前后血清乳酸脱氢酶、肌酸激酶和淀粉酶的变化.结果 所有患者未发展至失代偿期,治疗前丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)值和HBV-DNA定量分别为(110.5±30.2)U/L、(80.6±35.6) U/L、(26.7±12.6) μmol/L和(8.3±3.2)×106copies/ml,治疗后分别为(33.5±16.8)U/L、(29.3±12.8) U/L、(18.2±8.3) μmol/L和(2.6±1.3)×102copies/ml,治疗前后差异均有统计学意义(t =17.26、10.51、4.36、12.67,均P＜0.05).治疗过程中未发现与应用恩替卡韦相关的乳酸酸中毒和肾损害发生,也未见血清肌酸激酶或淀粉酶升高现象.结论 代偿期乙型肝炎肝硬化患者选用恩替卡韦分散片治疗有良好的疗效及安全性.     

恩替卡韦治疗乙型肝炎肝硬化失代偿期患者96周临床观察

目的研究恩替卡韦治疗乙型肝炎肝硬化失代偿期患者96周疗效、YMDD变异和安全性。方法 57例乙型肝炎肝硬化失代偿期患者随机分为两组,A组28例予拉米夫定100mg/d;B组29例恩替卡韦0.5mg/d治疗。以上两组的疗程为96周。均给予常规护肝及支持、对症治疗。观察两组患者HBVDNA定量、Child-Pugh评分变化、YMDD变异及药物不良反应情况。结果两组患者治疗后均有明显的HBVDNA转阴率和Child-Pugh评分改善,但两组之间进行这两项比较时差异无统计学意义(P>0.05)。拉米夫定组治疗48周时发生YMDD变异,随着时间延长,变异数增加,而恩替卡韦组未发生变异。72周后两组比较差异有统计学意义(P<0.05)。拉米夫定组有2例死亡,恩替卡韦组1例死亡,未发生与药物相关的严重不良反应。结论恩替卡韦治疗乙型肝炎肝硬化失代偿期患者96周,其疗效与安全性与拉米夫定相似,但能显著减少YMDD变异的发生,是一种有效且理想的治疗乙型肝炎肝硬化失代偿期的药物。     

恩替卡韦对慢性乙型肝炎、肝硬化代偿期和失代偿期的2年抗病毒疗效比较

目的分析对比恩替卡韦对慢性乙型肝炎、肝硬化代偿期和失代偿期的2年抗病毒疗效。方法对我院在2014年1月至2016年12月收治的慢性乙型肝炎患者(30例,甲组)、肝硬化代偿期患者(30例,乙组)、肝硬化失代偿期患者(30例,丙组)纳入本次实验,所有患者均给予恩替卡韦治疗,对比三组患者临床疗效。结果甲、乙、丙三组患者AST、ALT、HBeAg、HBVDNA、ALB、TBIL、CHE均无明显差异(P> 0.05),三组患者不良反应发生率也较比较接近(P> 0.05)。结论恩替卡韦治疗慢性乙型肝炎、肝硬化代偿期和失代偿期均能获得较好的疗效,且不良反应少,安全性高。     

恩替卡韦联合中药复方治疗失代偿期乙型肝炎肝硬化效果观察

目的探讨恩替卡韦联合中药复方对失代偿期乙型肝炎肝硬化的临床疗效。方法选择20例乙型肝炎病毒(HBV)复制的失代偿期肝硬化,在综合治疗基础上口服恩替卡韦0.5mg/d进行抗HBV治疗,并联合中药复方(由黄芪、云苓、白术、当归、丹参、鳖甲、蚤休、半枝莲、虎杖组成)颗粒剂进行抗肝纤维化治疗,疗程为6个月。观察治疗前后肝功能指标、血清学和病毒学应答情况及血清肝纤维化指标变化,同时观察不良反应的发生情况。结果20例治疗后肝功能及血清肝纤维化指标明显改善,与治疗前比较差异均有统计学意义(P0.05),HBV-DNA转阴率为85%(17/20)。结论恩替卡韦联合中药复方治疗失代偿期乙型肝炎肝硬化效果肯定,可达到控制病情、延长生命、提高生活质量的目的。     

恩替卡韦治疗失代偿期HBV-DNA阴性乙肝肝硬化48周疗效观察

目的 观察恩替卡韦治疗HBV-DNA阴性失代偿期乙肝肝硬化患者疗效.方法 80例失代偿期HBV-DNA阴性乙肝肝硬化患者,随机分为治疗组和对照组:均给予常规保肝及对症治疗外,治疗组另给予恩替卡韦0.5 mg,1次/d口服,观察治疗前、治疗后12、24、48周生化指标及不良反应.结果 治疗组肝功能恢复情况及Child-Pugh积分均优于对照组(P<0.01),未见明显不良反应.结论 恩替卡韦治疗失代偿期HBV-DNA阴性乙肝肝硬化具有良好的疗效和安全性,能提高患者的生存质量,改善预后.     

替比夫定与阿德福韦酯联用及恩替卡韦单药治疗失代偿期乙型肝炎肝硬化

目的观察分析替比夫定与阿德福韦酯联用及恩替卡韦单药治疗失代偿期乙型肝炎肝硬化的临床疗效。方法选取我院2014年5月至2016年1月收治的100例失代偿期乙型肝炎肝硬化患者为研究对象,随机分为对照组与观察组,每组50例。对照组给予恩替卡韦治疗,观察组给予替比夫定联合阿德福韦酯治疗,比较两组临床疗效。结果治疗后,两组血清总胆红素、白蛋白、凝血酶原活动度相比,P>0.05差异无统计学意义。结论联合应用替比夫定和阿德福韦酯治疗失代偿期乙型肝炎肝硬化与恩替卡韦单药治疗的临床疗效一致,均能有效抑制病毒复制。     

恩替卡韦治疗失代偿期乙型肝炎肝硬化的临床疗效观察

目的分析恩替卡韦治疗失代偿期乙型肝炎肝硬化的临床疗效。方法选取失代偿期乙型肝炎肝硬化患者86例,随机分为两组各43例,两组均实施常规治疗,在此基础上对照组给予拉米夫定治疗,观察组给予恩替卡韦治疗,比较两组治疗效果。结果治疗后观察组总胆红素、胆碱酯酶、丙氨酸氨基转移酶与凝血酶原时间等肝功能指标均优于对照组(P<0.05)。治疗后观察组HBV-DNA水平(1.9±0.8)log copies/mL显著低于对照组的(3.6±1.0)log copies/m L,HBV-DNA阴转率97.7%显著高于对照组的72.1%(P<0.05)。结论在失代偿期乙型肝炎肝硬化治疗中,恩替卡韦可发挥显著疗效,促使患者肝功能得到改善,值得临床推广。     

分析温阳益气汤联合恩替卡韦治疗老年失代偿期乙型肝炎后肝硬化患者的临床疗效

目的对于老年失代偿期乙型肝炎后肝硬化的患者采取治疗方法选择温阳益气汤联合恩替卡韦的方法,分析其临床疗效。方法本研究所涉及的对象为我院在2015年7月至2017年7月失代偿期乙型肝炎后肝硬化的老年患者80例,随机选取40例患者采取单一的恩替卡韦进行治疗,作为对照组,而剩下的40例患者在选择恩替卡韦进行治疗的基础上加以温阳益气汤联合治疗,作为联合组。以两组患者治疗后肝功能指标以及血清肝纤维化指标作为观察指标。结果结果显示,联合组在肝功能指标和血清肝纤维化指标水平改善情况优于对照组的,采取统计学进行分析,具有明显差别P<0.05。结论在对老年失代偿期乙型肝炎后肝硬化患者选取治疗方案时可以考虑温阳益气汤和恩替卡韦进行治疗,具有明显疗效,可以提高肝功能恢复效果。     

国产阿德福韦酯治疗乙型肝炎肝硬化的安全性与疗效观察

目的：观察国产阿德福韦酯（亿来芬）治疗代偿期乙型肝炎肝硬化的安全性与临床效果。方法：70例乙型肝炎肝硬化失代偿期患者随机分成两组,分别给予国产与合资企业产阿德福韦酯治疗72周,观察生化学指标、HBV DNA阴转、HBeAg阴转、抗-HBe阳转以及组织学指标炎症活动度（G）分级和纤维化程度（S）分期的差异。结果：两组患者生化指标均有明显改善,两组HBeAg血清转换率分别为26.09%和27.27%,HBV DNA阴转率两组分别为42.86%和45.71%,两组G分级和S分期均有明显改善,以上各项指标两组比较均无统计学意义（P〉0.05）。结论：国产和合资企业产阿德福韦酯治疗乙型肝炎肝硬化有相同的安全性和疗效。     

Treatment paradigms on hepatitis B e antigen-negative chronic hepatitis B patients

The primary goal of treatment in hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B (CHB) is potent and durable suppression of hepatitis B virus (HBV) replication. It results in biochemical and histological remission of CHB and is the prerequisite for the prevention of cirrhosis, its life-threatening complications and hepatocellular carcinoma. Responses that are durable after the cessation of treatment are referred to as sustained virological responses, whereas those persisting under therapy are referred to as treatment-maintained virological responses. Treatment paradigms of sustained virological response in HBeAg-negative CHB are practically restricted to conventional IFN-α and pegylated interferons (peg-IFNs), and are limited only to patients with compensated liver disease. Long-lasting maintained virological responses without HBV resistance in HBeAg-negative CHB are achievable by all approved nucleos(t)ide analogues (lamivudine, adefovir and entecavir) in highly variable rates, depending on their potency, rapidity of virological response and genetic barrier to resistance. The maintenance of response under 5 years of adefovir treatment represents the most effective treatment paradigm for HBeAg-negative CHB, whereas such long-term data with entecavir and tenofovir monotherapy may become available in the near future. In patients with lamivudine-resistant HBV mutants, the recommended treatment strategy is to add adefovir at the same time as continuing treatment with lamivudine. There are no treatment paradigms as yet of combination therapy from the very outset with two nucleoside analogues for use in treatment-naive patients.     

Treatment paradigms on hepatitis B e antigen-negative chronic hepatitis B patients

The primary goal of treatment in hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B (CHB) is potent and durable suppression of hepatitis B virus (HBV) replication. It results in biochemical and histological remission of CHB and is the prerequisite for the prevention of cirrhosis, its life-threatening complications and hepatocellular carcinoma. Responses that are durable after the cessation of treatment are referred to as sustained virological responses, whereas those persisting under therapy are referred to as treatment-maintained virological responses. Treatment paradigms of sustained virological response in HBeAg-negative CHB are practically restricted to conventional IFN-alpha and pegylated interferons (peg-IFNs), and are limited only to patients with compensated liver disease. Long-lasting maintained virological responses without HBV resistance in HBeAg-negative CHB are achievable by all approved nucleos(t)ide analogues (lamivudine, adefovir and entecavir) in highly variable rates, depending on their potency, rapidity of virological response and genetic barrier to resistance. The maintenance of response under 5 years of adefovir treatment represents the most effective treatment paradigm for HBeAg-negative CHB, whereas such long-term data with entecavir and tenofovir monotherapy may become available in the near future. In patients with lamivudine-resistant HBV mutants, the recommended treatment strategy is to add adefovir at the same time as continuing treatment with lamivudine. There are no treatment paradigms as yet of combination therapy from the very outset with two nucleoside analogues for use in treatment-naive patients.     

优化方案治疗阿德福韦酯初治失败的慢性乙型肝炎患者的疗效分析

目的观察恩替卡韦单药序贯与拉米夫定联合阿德福韦酯治疗阿德福韦酯初治失败的慢性乙型肝炎患者的临床疗效及安全性。方法选择阿德福韦酯初治失败的慢性乙型肝炎患者213例．随机分为A组104例、B组109例;A组患者改用恩替卡韦单药治疗,B组患者予以拉米夫定联合阿德福韦酯治疗;至48周时分别观察、比较其血清HBV DNA水平中位数下降幅度、血清HBV DNA阴转率、HBeAg转阴率、生化学应答率。血清HBV DNA阴转患者继续原方案治疗至96周,并观察其维持血清HBV DNA阴转率、HBeAg转阴率、HBV基因耐药变异率及不良反应。结果治疗48周,两组患者血清HBV DNA水平中位数下降幅度、血清HBV DNA阴转率、HBeAg转阴率及生化学应答率,差异均无统计学意义（P均〉0．05）。血清HBV DNA阴转患者继续原方案治疗至96周．两组患者维持血清HBV DNA阴转率、HBeAg转阴率及HBV基因耐药变异率．差异均无统计学意义（P均〉0．05）。两组患者均无严重不良事件。结论阿德福韦酯初治失败的慢性乙型肝炎患者予以拉米夫定联合阿德福韦酯治疗或改用恩替卡韦单药治疗．均能取得较好的临床疗效;两种优化方案维持血清HBV DNA阴转率、HBeAg转阴率率及HBV耐药变异率均无明显差异,安全性良好均适用于患者临床治疗。     

Entecavir: a review of its use in the treatment of chronic hepatitis B in patients with decompensated liver disease

The oral deoxyguanosine nucleoside analogue entecavir (Baraclude?) has potent activity against hepatitis B virus (HBV) and a high genetic barrier to resistance. This article reviews the clinical efficacy and tolerability of entecavir in the treatment of chronic hepatitis B in patients with decompensated liver disease, as well as summarizing its pharmacological properties. Entecavir 1?mg/day was more effective than adefovir dipivoxil 10?mg/day in the treatment of patients with chronic hepatitis B and decompensated liver disease, according to the results of a randomized, open-label, multicentre trial. Patients were either nucleos(t)ide naive or lamivudine experienced. The reduction from baseline in HBV DNA levels at week 24 (primary endpoint) was significantly greater with entecavir than with adefovir dipivoxil. The proportion of patients with HBV DNA levels of <300 copies/mL was also significantly greater with entecavir than with adefovir dipivoxil at weeks 24, 48 and 96, as was the proportion of patients with ALT normalization. Entecavir 0.5 or 1?mg/day, tenofovir disoproxil fumarate 300?mg/day and a fixed-dose combination of emtricitabine/tenofovir disoproxil fumarate 200?mg/300?mg per day were effective in the treatment of chronic hepatitis B in patients with decompensated liver disease, according to the 48-week analysis of a randomized, double-blind, multicentre trial, primarily designed to examine tolerability endpoints. In this trial, over one-third of patients had received previous therapy with lamivudine for ≥6 months. The efficacy of entecavir in treatment-naive patients with HBV-related decompensated cirrhosis did not significantly differ from that seen in patients with chronic hepatitis B or compensated cirrhosis (compensated group), according to the results of a prospective, nonrandomized study. After 6 or 12 months of entecavir treatment, there were no significant differences between the decompensated and compensated groups in virological, biochemical or serological endpoints. In patients with decompensated cirrhosis, significant improvements from baseline in liver function were seen after 12 months of entecavir therapy. Oral entecavir was generally well tolerated in patients with chronic hepatitis B and decompensated liver disease, with most of the reported treatment-emergent adverse events consistent with decompensated liver disease. In the trial primarily designed to examine tolerability endpoints, there was no significant difference between patients receiving entecavir and those receiving tenofovir disoproxil fumarate with or without emtricitabine in terms of the proportion of patients experiencing tolerability failure or the proportion of patients with confirmed increases in serum creatinine levels of ≥0.5?mg/dL above baseline or confirmed serum phosphorus levels of <2.0?mg/dL at week 48 (co-primary endpoints). It has been suggested that the risk of lactic acidosis associated with oral nucleos(t)ide analogue therapy is increased in patients with highly impaired liver function. However, only one case of lactic acidosis was reported among entecavir recipients across two clinical trials in patients with chronic hepatitis B and decompensated liver disease. Moreover, small studies found that the risk of lactic acidosis was not increased in patients with chronic hepatitis B and decompensated liver disease who received entecavir, compared with patients with non-HBV decompensated liver disease. In conclusion, entecavir is a valuable agent for the first-line treatment of chronic hepatitis B in patients with decompensated liver disease.     

恩替卡韦治疗活动性乙型肝炎肝硬化42例临床观察

目的：探讨恩替卡韦治疗活动性乙型肝炎肝硬化的临床效果。方法：选择本院2007年8月～2009年8月活动性乙型肝炎肝硬化患者82例,将以上患者随机分为两组,观察组和对照组。对照组患者采用常规治疗,观察组在常规治疗基础上给予恩替卡韦。两组患者疗程为48周。测定两组患者治疗前和治疗后生化指标;测定两组患者治疗后HBV-DNA阴转率、HBeAg血清转换率等。结果：观察组治疗后TBIL、ALT、ALB、Child-pugh评分与对照组治疗后比较,差异有统计学意义（P〈0.05）;观察组治疗后HBV-DNA转阴率和HbeAg血清转换率分别与对照组比较,差异有统计学意义（P〈0.05）。结论：恩替卡韦能够快速抑制乙肝病毒复制,改善患者临床症状和生化指标,临床效果显著,值得借鉴。     

恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎疗效观察

目的观察恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎患者的临床效果。方法选取2017年9月-2019年1月河北医科大学第三医院收治的耐干扰素乙型肝炎患者120例,随机分为观察组和对照组,每组60例。2组均给予IFNα-2b肌肉注射治疗,观察组在此基础上给予恩替卡韦联合拉米夫定治疗。比较2组病毒学应答率、乙型肝炎表面抗原(HBsAg)转阴率,2组治疗前及治疗4、12、24周血清纤维化指标。结果观察组病毒学应答率为100. 0%,高于对照组的6. 67%(P <0. 05);观察组HBsAg转阴率为41. 67%,高于对照组的0%(P <0. 05);治疗4周后,2组透明质酸钠(HA)、层粘连蛋白(LN)、Ⅳ型胶原(C-Ⅳ)均低于治疗前,且观察组低于对照组(P <0. 05);2组Ⅲ型前胶原(PC-Ⅲ)水平比较差异无统计学意义(P> 0. 05);治疗12周后,观察组HA、LN、C-Ⅳ、PC-Ⅲ指标值均低于对照组(P <0. 05)。结论恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎效果较好,可提高病毒学应答率和HBsAg转阴率,显著改善患者的肝纤维化水平,值得临床推广应用。     

Lamivudine monotherapy in HBeAg-negative chronic hepatitis B: prediction of response-breakthrough and long-term clinical outcome

BACKGROUND: Factors that predict response and breakthrough phenomenon to lamivudine monotherapy in patients with HBeAg-negative chronic hepatitis B have not been well defined. AIM: To determine pre-treatment and on treatment variables that predict initial response and breakthrough in patients with HBeAg-negative chronic hepatitis B receiving long-term lamivudine. METHODS: Seventy-nine patients, with chronic HBeAg-negative hepatitis B, who received lamivudine for a median of 31 months were included in the study. RESULTS: Initial virologic and biochemical response was observed in 73 (92%) and 70 (89%) patients, respectively, while 34 (47%) and 15 (21%) patients developed virological and biochemical breakthrough, respectively. High levels of necroinflammation in liver biopsy were associated with a higher probability of initial virological and biochemical response. Patients with pre-treatment serum hepatitis B virus DNA concentrations of more than 10(6) copies/mL were three times more likely to develop virologic breakthrough. Two patients died, one with baseline cirrhosis because of liver failure during biochemical breakthrough while the second death was liver and treatment unrelated. CONCLUSIONS: In HBeAg-negative chronic hepatitis B, initial response to lamivudine therapy is associated with necroinflammation, while baseline serum hepatitis B virus DNA exceeding 10(6) copies/mL is a strong predictor for breakthrough because of drug-resistant mutations. Severe complications are uncommon and are associated with biochemical breakthrough and pre-existing cirrhosis.     

恩替卡韦初始治疗与接续阿德福韦序贯治疗的抗乙肝病毒疗效观察

目的:观察慢性乙型肝炎采用恩替卡韦初始治疗与接续阿德福韦序贯治疗的抗病毒疗效。方法:HBeAg阳性的慢性乙型肝炎患者63例分为初始组(35例)与序贯组(28例),序贯组为服用阿德福韦耐药或疗效不佳的患者。均采用恩替卡韦单药治疗,0.5mg,qd,同时适量加用保肝降酶药。定期检测病毒学和生化学指标。结果:初始组HBVDNA低于不可测水平的例数在治疗第6个月以后明显高于序贯组,在治疗12个月时达到94.3%(P<0.05);初始组HBeAg和HBeAb的S/CO值在治疗第8个月后明显低于序贯组,在治疗第12个月时有3例(8.6%)HBeAg/HBeAb转换,序贯组无HBeAg/HBeAb转换。生化学指标的变化2组差异无统计学意义,在治疗第6个月以后2组生化学指标均复常。结论:恩替卡韦初始治疗的抗病毒效果明显优于阿德福韦耐药或疗效不佳的序贯治疗。