替比夫定与拉米夫定治疗慢性乙型肝炎的临床观察

目的探讨替比夫定和拉米夫定治疗慢性乙型肝炎的疗效和不良反应。方法采用1：1随机、对照设计。共纳入慢性乙型肝炎患者120例，其中HBeAg阳性和阴性各60例，各组分为替比夫定组和拉米夫定组各30例。分别口服替比夫定600mg，1次／d，拉米夫定100mg，1次／d，共52周。观察比较两组临床疗效及不良反应，并动态监测患者血清HBsAg、HBeAg水平的变化。结果治疗52周时，HBeAg阳性和阴性患者中，替比夫定组血清HBVDNA自基线下降水平、HBVDNA低于检测下限的比率、病毒反跳率和耐药率，均优于拉米夫定组（均P〈0．05）。HBeAg阳性患者中替比夫定组HBeAg阴转率和治疗应答反应率高于拉米夫定组（均P〈0．05）；两组不良反应差异无统计学意义（P〉0．05）。结论替比夫定治疗慢性乙型肝炎的疗效优于拉米夫定，患者对替比夫定的耐受性较好。

Clinical observation of telbivudine and lamivudine in treament of patients with chronic hepatitis B

Objective To investigate the efficacy and side effects of telbivudine and lamivudine for treatment of chronic hepatitis B for 1 year. Methods In this random and control study,the efficacy of telbivudine and lamivudine treatments were compared in 120 patients who consisted of 60 cases with HBeAg-negative and 60 cases with HBeAg-positive chronic hepatitis B.The patients were randomly assigned to a daily 600mug telhivudine treatment group or daily 100mg lamivudine group for 52 weeks.The clinical efficacy and adverse reactions of the two groups were observed in control after 52 weeks of therapy,and dynamics of serum HBsAg,HBeAg levels were monitored and compared. Results At week 52,mean reductions of serum HBV DNA from baseline and undetectable serum HBV DNA rates among patients with HBeAg-negative and HBeAg-positive chronic hepatitis B were significantly greater in the telbivudine-treated patients than in the lamivudine-treated group(all P＜0.05).Viral resistance and viral breakthrough was significant common in lamivudine compared with telbivudine(all P＜0.05).Among patients with HBeAg-positive chronic hepatitis B,telbivudine was significant superior to lamivudine with respect to loss of HBeAg(P＜0.05).There was no significant difference in side effects between patients treated with tebivudine and Iamivudine. Conclusion Telbivudine was more effective than lamivudine in treatment of patients with chronic hepatitis B,and the drug was well tolerated.