两组核苷类似物治疗耐药性HBeAg阴性慢性乙型肝炎的疗效比较

目的 比较恩替卡韦和阿德福韦酯治疗拉米夫定耐药的HBeAg阴性慢性乙型病毒性肝炎的疗效及安全性。方法 拉米夫定耐药的HBeAg阴性慢性乙型病毒性肝炎患者65例随机分为两组：恩替卡韦治疗组33例,给予恩替卡韦1.0 mg/d;阿德福韦酯治疗组32例,给予阿德福韦酯10mg/d;动态观察患者血清HBV DNA、肝功能、血清磷酸肌酸激酶、肌酐的变化以及不良事件发生的情况。结果 恩替卡韦治疗组ALT复常率在治疗后12周、24周、48周均高于阿德福韦酯治疗组,但直到48周时两组之间的差异仍无统计学意义（P＞0.05）;恩替卡韦治疗组HBV DNA转阴率在治疗12周时明显高于阿德福韦酯治疗组,差异有统计学意义（P＜0.05）。结论 恩替卡韦与阿德福韦酯对于拉米夫定耐药的HBeAg阴性慢性乙型病毒性肝炎均有较好疗效,恩替卡韦可能有更好的治疗效果。

Efficacy of two nucleoside analogs to treat resistant HBeAg-negative chronic hepatitis B

Objective To observe the therapeutic effect and safety of entecavir and adefovir in the treatment of lamivudine-resistant HBeAg-negative chronic hepatitis B. MethodsSixty-five patients with lamivudine-resistant HBeAg-negative chronic hepatitis B were randomly divided into two groups. The entecavir treatment group included 33 patients, who were administrated entecavir 1.0 mg/d. The adefovir treatment group included 32 patients, who were administrated adefovir dipivoxil 10 mg/d. Changes in serum HBV DNA, liver functions, phosphocreatine kinase, creatinine and adverse reaction were dynamically monitored. ResultsAt the end of the 12th, 24th, 48th week of treatment, the rates of serum ALT normalization of the entecavir treatment group were higher than that of the adefovir treatment group, but there wasn't statistically difference between two groups until the end of the 48 th week of treatment( P ＞ 0. 05 ).The rate of sera to turn negative for HBV DNA of the entecavir treatment group was significantly higher than that of the adefovir treatment group at the end of the 12th week. Moreover, the difference was statistically significant( P ＜ 0.05 ). ConclusionBoth entecavir and adefovir dipivoxil might have a good response to lamivudine-resistant HBeAg-negative chronical hepatitis B. Entecavir could achieve better therapeutic effects.