恩替卡韦与替比夫定对治疗HBeAg阳性慢性乙型肝炎患者疗效及预测因素分析

目的 观察恩替卡韦与替比夫定治疗HBeAg阳性慢性乙型肝炎（CHB）患者的疗效及预测因素分析. 方法 将159例HBeAg阳性的CHB患者分为恩替卡韦分组（ETV组,81例）和替比夫定组（LDT组,78例）.治疗72周后,观察两组的应答情况生化学应答率（丙氨酸转氨酶转复率）、完全病毒学应答率（HBV-DNA阴转率）、血清学应答率（HBeAg阴转率及HBeAg血清学转换率）],并且分析在治疗24周HBV-DNA转阴情况对72周疗效的预测影响.结果 两组患者治疗后各时间段的生化学应答率比较均无统计学意义（P均＞0.05）.治疗4周后ETV组和LDT组的HBV-DNA值与治疗前比较差异均具有统计学意义（P均＜0.05）,且治疗24周后ETV组的HBV-DNA值明显低于LDT组（P＜0.05）,但治疗72周后比较两组患者的完全病毒学应答率比较差异不具有统计学意义（P均＞0.05）.治疗各时间点ETV组比LDT组有着更高的血清学应答率,但差异不具有统计学意义（P均＞0.05）.治疗24周HBV-DNA转阴（HBV-DNA＜3lg拷贝/ml）的患者,72周具有更高的生化学应答率及血清学应答率（P均＜0.05）.结论 恩替卡韦与替比夫定对治疗CHB具有很好的疗效及较低的耐药率和不良反应,恩替卡韦在早期抗HBV-DNA优于替比夫定片,且治疗24周的HBV-DNA水平可预测长期疗效.

Efficacy of entecavir and telbivudine in HBeAg positive chronic hepatitis B patients and their predictors

Objective To analyze the efficacy of entecavir and telbivudine on HBeAg positive chronic hepatitis B （CHB） and their predictors. Methods A total of 159 patients with HBeAg positive CHB were randomly divided into entecavir group （group ETV, 81 cases） and telbivudine group （group LDT, 78 cases）. The biochemical response rate, complete virological response rate and serologic response rate in the two groups were observed after treatment at 4, 12, 24, 48 and 72 weeks. The efficacy of 72 weeks was predicted by the HBV-DNA turn to negative or not after 24 weeks of treatment. Results The biochemical response rate had no significant differences between the two groups at 4, 12, 24, 48 and 72 weeks （all P〉 0.05）. The levels of HBV-DNA in the two groups were lower after 4 weeks treatment, and were much lower in group ETV than that in group LDT after 24 weeks （all P 〈 0.05）. However, thecomplete virological and serologic response rates showed no significant differences between the two group at 4, 12, 24, 48 and 72 weeks （all P 〉 0.05）. The biochemical and serologic response rates at 72 weeks in patients with HBV-DNA 〈 3 lg copy/ml at week 24 were much better than those in the patients with HBV DNA ≥ 3 lg copy/ml （all P 〈 0.05）. Conclusions Entecavir and telbivudine are effective and safe drug for initial treatment of CHB patients, and entecavir is better. Meanwhile, the level of HBV DNA at 24 weeks after treatment can predict long-term efficacy.