强效核苷类似物抗病毒过程中血清HBV DNA变化和HBeAg血清学转换分析

目的:探讨恩替卡韦及替比夫定治疗慢性乙型肝炎(慢乙肝)过程中血清HBV DNA水平变化和HBeAg血清学阴转率的差异.方法:选择初治慢乙肝患者126例,按其治疗方案分为恩替卡韦0.5 mg/d治疗组(恩替卡韦组)83例和替比夫定600 mg/d治疗组(替比夫定组)43例,观察两组慢乙肝患者治疗前及治疗4、8、12、24、48周时血清HBV DNA水平、阴转率及其下降模式,比较治疗48周时HBeAg血清学阴转率.结果:治疗4周时思替卡韦组和替比夫定组HBeAg阳性患者HBV DNA水平分别为(5.57±1.30)lg copies/L、(5.76±1.34)lg copies/L,两组HBeAg阴性患者则分别为(5.75±1.01)lg copies/L、(6.03±1.86)lg copies/L,两组HBV DNA水平与治疗前比较差异均有统计学意义(P均<0.05),但两组组间比较差异无统计学意义(P>0.05).两组HBeAg阳性患者各个时间点HBV DNA阴转率比较差异均无统计学意义(P>0.05);恩替卡韦组HBeAg阴性患者除24周外的HBV DNA阴转率均明显高于替比夫定组HBeAg阴性患者(P均<0.05).无论是HBeAg阳性患者还是HBeAg阴性患者,两组的病毒下降模式比较差异无统计学意义(P>0.05).两组治疗48周HBeAg阴转率比较差异无统计学意义(P>0.05).结论:两种核苷类似物均能快速、强效抑制HBV DNA;对于HBeAg阴性患者,恩替卡韦治疗较替比夫定治疗可获得更高的HBV DNA阴转率.

Serum HBV DNA and HBeAg seroconversion after potent nucleoside analogues antiviral therapy

Objective: To evaluate the serum HBV-DNA levels and HBeAg seroconversion in patients with chronic hepatitis B(CHB) after entecavir and telbivudine antiviral therapy.Methods: One hundred and twenty-six patients with CHB were enrolled,including 83 patients treated with entecavir(0.5 mg) and 43 patients treated with telbivudine(600 mg).Blood samples were collected at the baseline and 4,8,12,24 and 48 weeks after treatment.The serum HBV-DNA concentration,conversion rate and the decline patterns were recorded,as well as the HBeAg seroconversion rate.Results: At Week 4,in HBeAg-positive patients,serum HBV-DNA were 5.57±1.30 and 5.76±1.34 lg copies/L in entecavir and telbivudine group,respectively;while in HBeAg negative patients were 5.75±1.01 and 6.03±1.86 lg copies/L,respectively.There were significant reduction in HBV-DNA in the 4 subgroup when compared to baseline(P<0.05),however,no significant difference was revealed among them(P>0.05).There was no significant difference in HBV-DNA conversion rate between HBeAg-positive patients and HBeAg-negative patients(P>0.05).However,it was significantly higher in the entecavir group than that in the telbivudine group,except for Week 24.Either in HBeAg positive or HBeAg-negative patients,there was no significant difference in the HBV decline pattern between the entecavir group and the telbivudine group(P>0.05),neither in the HBeAg seroconversion rate at week 48(P>0.05).Conclusions: Both the nucleoside analogues have rapid and potent inhibition of HBV DNA.In HBeAg-negative patients,entecavir provides more prominent HBV DNA conversion.