恩替卡韦治疗乙型肝炎rtA181变异患者的疗效观察

目的 观察恩替卡韦rtA181变异的临床疗效。方法 61例接受核苷（酸）类药物抗病毒治疗期间出现rtA181变异的患者换用恩替卡韦治疗,在发生病毒变异时、治疗6个月、12个月时对这些患者的临床生化和病毒学指标进行了观察,并观察不良反应。结果 换用恩替卡韦治疗6个月时患者生化指标Tbil、Dbil、ALT、AST的正常率分别是86.9％、93.4％、82.0％、95.1%,治疗12个月时相关指标的正常率分别是88.5％、96.7％、86.9％、98.4%。换药治疗6个月时47例患者HBV DNA阴转,HBeAg阴性率24.6%,其病毒水平较换药前存在显著性差异（4.60 ± 1.10 lg copies/ml vs. 0.79 ± 1.60 lg copies/ml,P<0.01）;换用ETV 12个月时54例患者HBV DNA转阴,HBeAg阴性率24.6%。仅有2例患者发生轻微不良反应,未影响正常治疗。结论 恩替卡韦单药治疗rtA181变异能够有效抑制HBV DNA、改善生化学指标,且具有较好的安全性。

The efficacy of entecavir in patients with rtA181 mutant chronic hepatitis B

Objective To observe the clinical efficacy of Entecavir rescue rtA181 mutation patients. Methods 61 patients switching to Entecavir therapy after appearing rtA181 mutation during Nucleos(t)ide analogues antiviral treatment. Clinical virological and biochemical indicators of these patients were observed at appearing mutation, 6 iaomonths and 12 months. Adverse reactions were observed at the same time. Results Tbil, Dbil, ALT, AST normal rates were 86.9%, 93.4%, 82.0%, 95.1% after switching to Entecavir treatment for 6 months, and these indicators were 88.5% , 96.7%, 86.9%, 98.4% after 12 months treatment. After 6 months Entecavir treatment, HBV DNA of 47 patients seroconversion, HBeAg-negative rate is 24.6%, there was a significant viral levels difference than before (4.60 ± 1.10 lg copies / ml vs. 0.79 ± 1.60 lg copies / ml, P <0.01). 54 patients have HBV DNA seroconversion and HBeAg-negative rate is 24.6% after switching to ETV 12 months. Only two cases appear adverse reactions during the treatment, and it does not affect the normal treatment. Conclusion Entecavir monotherapy could suppress rtA181 mutation virus, improve biochemical indicators and it has good drug safety.