替比夫定治疗122例慢性乙型肝炎疗效及影响因素观察

目的 观察初治、单一使用替比夫定的慢性乙型肝炎（CHB）患者48周的临床疗效和e抗原血清学转换的基线影响因素.方法 选择杭州市西溪医院和浙江大学附属第一医院感染科门诊初治、单一使用替比夫定治疗的122例CHB患者,HBeAg阳性组97例和HBeAg阴性组25例,给予口服替比夫定600mg,1次/天,连续治疗48周,观察患者基线水平及治疗12、24、48周时HBV-DNA阴转（＜lg3拷贝/毫升）率、ALT复常（≤1.0×ULN）率、HBeAg血清转阴率和HBeAg血清学转换率.以97例HBeAg阳性组治疗48周时HBeAg血清学转换与否分为转换组和未转换组,比较两组基线ALT水平、HBVDNA和HBeAg定量有无统计学意义.结果 122例CHB患者12、24和48周HBV DNA阴转率分别为60.7％、78.7％、88.5％,丙氨酸氨基转移酶（ALT）复常率分别为59.0％、80.3％、87.7％,97例HBeAg阳性组患者12、24和48周时HBeAg血清转阴率分别为17.5％、23.7％、32.0％,HBeAg血清学转换率分别为12.7％、15.5％、30.9％.HBeAg血清学转换组基线ALT水平449.73 ±431.91U/L高于未转换组253.19±306.30U/L,差异有统计学意义（P =0.012）,基线性别、年龄、HBVDNA和HBeAg定量两组比较无统计学差异（P＞0.05）.结论 替比夫定治疗48周具有较高的HBVDNA阴转率、ALT复常率、HBeAg转阴率和血清学转换率;较高的基线ALT水平是e抗原血清学转换的独立预测因子.

Efficacy and Influential Factor of Telbivudine Treatment in 122 Patients with Chronic Hepatitis B

Objective To investigate the efficacy and baseline influential factor of HBeAg seroconversion with telbivudine（LDT）monotherapy in treatment-naive in chronic hepatitis B（CHB） patients for 48 weeks.Methods Totally 122 patients with CHB,in duding HBeAg-positive group of 97 cases and HBeAg-negative group of 25 cases,who received monotherapy of telbivudine in the department of infectious diseases in Hangzhou Xixi Hospital and the first affiliated hospital of Zhejiang medical university took telbivudine 600 mg orally once per day.The efficacy measures included the proportion of patients with undetectable serum HBV DNA （＜ lg3 copies/ml）,normalization of ALT level ≤ 1.0 × the upper level of normal （ULN）],HBeAg loss,HBeAg seroconversion were obsorred at baseline and week 12,week 24,week 48.Ninety-Seren HBeAg-positive CHB patients divided into two group differentlv with HBeAg seroconversion at week 48,and the level of ALT,HBVDNA,HBeAg between the two groups at baseline was compared.Results The undetectable rates of HBVDNA at week 12,week 24,week 48 were 60.7％,78.7％,88.5％ of 122 patients respectively.Normalization of ALT level were 59.0％,80.3％,87.7％ respectively.The rates of HBeAg loss at week 12,week 24,week 48 werel7.5％,23.7％,32.0％ and HBeAg seroconversion were 12.7％,15.5％,30.9％ in 97 HBeAg-positive patients respectively.The group of HBeAg seroconversion showed higher baseline ALT level （449.73 ± 431.91U/L vs 253.19 ± 306.30U/L,P =0.012）.No significant difference was observed in baseline of gender,age,HBVDNA and HBeAg quantity between two groups.Conclusion CHB patients accepting LDT treatment for 48 weeks had high rates of undetectable HBV DNA,normalization of ALT level,HBeAg loss and HBeAg seroconversion.High baseline ALT level is a independent predictor for HBeAg seroconversion with the treatment of telbivudine（LDT）.