两种用药策略治疗HbeAg阴性慢性乙肝的疗效研究

目的比较阿德福韦酯联合拉米夫定和单用恩替卡韦治疗HBeAg阴性的慢性乙肝患者的疗效。方法276名HBeAg阴性慢性乙型肝炎的门诊患者分为两组：阿德福韦酯联合拉米夫定组和单用恩替卡韦组，分别用药治疗24个月，治疗前、治疗后6，12，和24月采集静脉血，分别检测HBV—DNA、AIJ、AST和T—Bil，随访时对患者进行常规检查．记录不良反应。结果两组患者治疗后的ALT、AST、T—Bil水平均显著降低，治疗后同时间段两组间的ALT复常率，x2=3．63，x^20.05（2）=5．99，x2〈x^20.05（2），则P〉0．05，差异无统计学意义；同时间段两组间HBV—DNA转阴率，x^2=0，x^20.05（2）=5．99，x^2〈x0.05（2），P〉0．05，差异无统计学意义，但恩替卡韦组转阴率比联合用药组高些。结论阿德福韦酯联合拉米夫定或恩替卡韦单用治疗对拉米夫定耐药的HBeAg阴性慢性乙型肝炎患者均有效．但恩替卡韦单用治疗比联合用药HBV—DNA转阴效果好些。

Curative effect of two strategies of drug treatment for HbeAg-negative chronic hepatitis B

Objective To compare the curative effect of adefovir dipivoxil plus lamivudine and entecavir alone in the treatment of HbeAg-negative chronic hepatitis B. Methods A total of 276 cases of outpatients with HbeAg-negative chronic hepatitis B were divided into two groups： adefovir dipivoxil plus lamivudine group and entecavir group, treated for 24 months respectively, collected the venous blood to detect the HBV-DNA,ALT,AST and T-Bil after the treatment of 6,12 and 24 months,during follow-up, proceed the routine inspection and recorded the adverse reactions for the patients. Results The ALT, AST,T-Bil levels of two groups after treatment were significantly reduced, the regular rate of ALT in the same period between the two groups were not significant different（X2=3.63, X^20.05（2）=5.99, X^2〈X^20.05（2）, P 〉 0.05）; the regular rate of HBV-DNA in the same period between the two groups were not significant different（x^2=0 X^20.05（2）, X^20.05（2）=5.99,X^2〈X^20.05（2）, P 〉 0.05） ,but the regular rate of HBV-DNA in enteeavir group was higher than the combination group. Conclusion Adefovir dipivoxil plus lamivudine and entecavir alone in the treatment of HbeAg-negative chronic hepatitis B patients with lamivudine resistance are effective,but the regular rate of HBV-DNA of entecavir therapy alone have better effect than the combination therapy of adefovir dipivoxil plus lamivudine.