恩替卡韦治疗耐阿德福韦酯慢性乙型肝炎的临床研究

目的：观察恩替卡韦治疗耐阿德福韦酯慢性乙型肝炎的疗效。方法随机选取2012年1月至2013年1月肝病门诊就诊的耐阿德福韦酯慢性乙型肝炎患者46例，停用阿德福韦酯，改用恩替卡韦分散片，用量0.5 mg/d，于治疗前及治疗后12周、24周、36周、48周检测肝功能、乙肝标志物等指标。结果治疗后第48周，患者HBV-DNA水平低于检测下限（〈5.00×102拷贝/mL）者，乙型肝炎病毒e抗原（ HBeAg ）阳性组25例，HBeAg阴性组19例，组间比较差异无统计学意义（ P＞0.05）；治疗后第12周、24周、36周、48周，患者ALT复常率HBeAg阳性组分别为46.15%，53.85%，88.46%，96.15%，HBeAg阴性组分别为35.00%，50.00%，85.00%，90.00%，组间比较差异无统计学意义（ P＞0.05）；治疗后第12周、24周、36周、48周，HBeAg阳性组HBeAg阴转率分别为26.92%，38.46%，46.15%，57.69%，HBeAg血清学转换率分别为34.62%，50.00%，61.54%，73.08%，其中12周与48周比较差异有统计学意义（ P〈0.05）。结论采用恩替卡韦治疗耐阿德福韦酯慢性乙型肝炎患者，疗效显著且不良反应少，值得推广。

Clinical Application of Entecavir for Treating Adefovir Ester Resistant Chronic Hepatitis B

Objective To study the effect of entecavir （ ETV ） for treating adefovir ester （ ADV ） resistant chronic hepatitis B. Methods 46 cases of ADV resistant chronic hepatitis B in the liver diseases clinic from January 2012 to January 2013 were randomly selected, stopped ADV and switched to ETV, 0. 5 mg/d. The liver function, ATL, 5 items of hepatitis B, HBV DNA and HBV markers were de-tected before treatment and at 12, 24, 36, 48 weeks after treatment. The curative effect of ETV was analyzed. Resuts The HBV-DNA levels at 48 weeks after treatment in 25 cases of the HBeAg positive group and 19 cases of the HBeAg negative group were below the lower detection limit （〈5. 00 × 102 IU/mL ） , the difference between before and after treatment in the two groups had statistical signifi-cance. The comparison between the HBeAg positive group and the HBeAg negative group showed no statistical difference （ P〉0. 05 ） . The HBeAg positive group were 46. 15%, 53. 85%, 88. 46% and 96. 15% respectively;the HBeAg negative group were 35. 00%, 50. 00%, 85. 00% and 90. 00% respectively, there was no statistically significant difference between the two groups （ P〉0. 05 ） , the difference be-tween before and after treatment in the two groups was statistically significant;the negative conversion rates at 12, 24, 36, 48 weeks after treatment in the HBeAg positive group were 26. 92%, 38. 46%, 46. 15%, 57. 69% respectively, the HBeAg serological conversion rates at 12, 24, 36, 48 weeks after treatment were 34. 62%, 50. 00%, 61. 54% and 73. 08% respectively, in which comparing 12 weeks and 48 weeks showed the statistical difference （ P〈0. 05 ） . Conclusion Adopting ETV for treating ADV resistant chronic hepatitis B has distinct effect, less adverse reaction and good safety.