核苷类药物对慢性乙型肝炎患者抗病毒作用的比较

目的比较替比夫定、思替卡韦、拉米夫定治疗慢性乙型肝炎抗病毒的疗效。方法选择慢性乙型肝炎病人HBeAg阳性、HBV-DNA≥10^5拷贝／mL、血清胆红素≤171μmol／L的123例病人，随机分为替比夫定（L-dT）组38例，恩替卡韦（ETV）组42例，拉米夫定（LAM）组43例。治疗2wk、4wk、8wk、12wk、24wk分别检测血清ALT、HBV-DNA水平及乙型肝炎血清学标志物（HBVM），并观察药物的安全性。结果替比夫定、恩替卡韦具有快速、强效的抑制HBV-DNA病毒的能力，24wk时分别为-5．8olglocopies／mL、-5．9olg10copies／mL，ALT复常率高，HBeAg阴转率、血清转换率均高于拉米夫定组（P〈0．01）.3种药物的不良反应发生率相比无统计学意义。结论替比夫定、恩替卡韦治疗慢性乙型肝炎HBV-DNA水平下降幅度、ALT复常率、HBeAg阴转率、血清转换率均较拉米夫定组显著，尤其在治疗8～12wk时，替比夫定的HBeAg阴转率更高。

Comparison of the effect of nucleotide drugs in treating chronic hepatitis B

Objective To compare the effect of Telbivudine, Entecavir and Lamivudine in treating chronic hepatits B. Methods 123 chronic hepatitis B patients with HBeAg （＋）, HBV DNA≥ 10^5copies/ml and serum bilirubin≤171μmol/L were randomly divided into Telbivudine group （L-dT）, Entecavir （ETV） group and Lamivudine （LAM） group. Serum ALT, HBV DNA and HBVM were assessed at weeks 2, 4, 8, 12, 24 and we evaluated the safety of drugs after the treatment. Results Telbivudine and Entecavir have faster and stronger ability to depress HBV-DNA （respectively down to -5.8log10copies/mL and -5.9log10copies/mL at 24th week）. And both of them also have higher ALT recovery rate, HBeAg darkening rate and frequency of seroconversion than Lamivudine group （P〈0.01）. Conclusions Compared to the Lamivudine group, the reduction of HBV-DNA, ALT recovery rate, HBeAg darkening rate and frequency of seroconversion of Telbivudine and Entecavir were both higher. Telbivudine have obviously higher HBeAg darkening rate especially after 8-12 weeks of treatment.