阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎的近期疗效观察

目的观察阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原(HBeAg)阳性慢性乙型肝炎2年的疗效。方法 2007年1月-2009年1月间178例慢性乙型肝炎患者随机分为试验组91例和对照组87例。试验组给予胸腺五肽1 mg,隔日皮下注射,疗程52周;同时阿德福韦酯10 mg/d口服104周。对照组给予阿德福韦酯10 mg/d,口服104周。治疗26、52、104周及停药52周时,分别检测血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、乙型肝炎病毒(HBV)DNA含量及HBV血清标志物。结果治疗52周后,试验组在ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率与HBeAg/HBeAb血清转换率方面都比对照组高。停药52周时,试验组与对照组的ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg/HBeAb血清转换率分别为74.73%与51.72%、75.82%与54.02%、25.27%与8.05%、26.37%与10.34%、18.68%与8.05%(χ2=10.652、9.313、9.421、7.574、4.313,P<0.05)。结论阿德福韦酯联合胸腺五肽治疗HBeAg阳性慢性乙型肝炎比单独使用阿德福韦酯抗病毒治疗效果更好,有助于提高HBeAg/HBeAb血清转换率,减少停药后病毒学突破,并且使用安全。

Short-term Therapeutic Effect of Adefovir Dipivoxil Combination with Thymopentin on Chronic Hepatitis B Patients with Positive Hepatitis B e Antigen

Objective To evaluate the efficacy of adefovir dipivoxil(ADV) combined with thymopentin on chronic hepatitis B patients with positive hepatitis B e antigen(HBeAg).Methods Between January 2007 and January 2009,178 chronic hepatitis B patients with positive HBeAg were randomly divided into two groups: the treatment group(91 cases) and the control group(87 cases).All patients in two groups received 10 mg of ADV once a day for 104 weeks,while the patients in the treatment group received 1 mg of thymopentin for subcutaneous injection every other day for 52 weeks.The rates of alanine aminotransferase(ALT) and aspartate aminotransferase(AST) normalization,serum hepatitis B virus(HBV) DNA clearance and HBeAg loss and anti-HBeAg seroconversion were evaluated at pretreatment,and 52,104 and 156 weeks after treatment,respectively.Results After 52-week treatment,The rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti-HBeAg seroconversion in the treatment group were higher than those in the control group.In 52-week follow-up after 104 weeks treatment,the rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti-HBeAg seroconversion of two groups were 74.73% versus 51.72%,75.82% versus 54.02%,25.27% versus 8.05%,26.37% versus 10.34%,18.68% versus 8.05%,respectively(χ2 = 10.652,9.313,9.421,7.574,4.313;P<0.05).Conclusions It is more effective for adefovir dipivoxil combined with thymopentin on HBeAg-positive patients with chronic hepatitis B than using adefovir alone.Combination treatment could improve the rates of HBeAg seroconversion and reduce the breakthrough of HBV after drug withdrawal.And it is safe.