恩替卡韦和阿德福韦酯对慢性乙型肝炎的临床疗效对比研究

目的：比较恩替卡韦（ETV）和阿德福韦酯（ADV）对HBeAg（＋）的慢性乙型肝炎（CHB）患者的临床疗效。方法：选择我院就诊的HBeAg（＋）的CHB患者82例，以1：1的比例随机分为ETV组和ADV组，分别给予ETV0．5mg和ADV10mg，均1次·d^-1，用药48周。比较治疗前，治疗后4、12、24和48周两组血清HBV-DNA水平、HBV·DNA阴转率（〈300copies·ml^-1）、HBeAg血清学转换率、血清ALT水平和不良反应。结果：随着观察期的延长，（1）两组血清HBV-DNA水平逐渐降低，且治疗后各时间点ETV组明显低于ADV组，差异有统计学意义（P〈0．05）；（2）两组血清HBV‘DNA阴转率逐渐增加，24、48周时ETV组转阴率均明显高于ADV组（分别P〈0．01，P〈0．05）；（3）两组HBeAg血清阴转率逐渐上升，但治疗后各时间点两组间差异无统计学意义（P〉0．05）；（4）两组血清谷氨酸氨基转移酶（ALT）水平逐渐降低，24周时ETV组ALT水平明显低于ADV组，差异有统计学意义（P〈0．05），但其他时间点两组差异无统计学意义（P〉0．05）。两组均无特殊不良反应发生。结论：对HBeAg（＋）的CHB患者，ETV较ADV更能有效地降低血清HBV—DNA水平，提高HBV—DNA阴转率，两者改善HBeAg血清阴转率和降低血清ALT水平的效果相当，无特殊不良反应，ETV优于ADV。

Comparison of therapeutic effects of entecavir and adefovir in HBeAg-positive chronic hepatitis B

Objective： To compare the antiviral efficacy of entecavir（ETV） and adefovir（ADV） on hepatitis B e antigen- positive [ HBeAg （ ＋ ） ] chronic hepatitis B （ CHB ） patients. Methods： Eighty- two HBeAg （ ＋ ） CHB patients were randomized to receive enteeavir 0.5 mg daily（ ETV group） and adefovir 10 mg daily（ ADV group） for 48 weeks by a 1：1 ratio. The serum HBV-DNA level, proportion of patients with undetectable serum HBV-DNA （ 〈 400 copies · ml-1）, rate of HBeAg seroconversion, and the serum alanine aminotransferase （ALT） were analyzed at baseline, 4, 12, 24 and 48 weeks during treatment. Results： As the administration proceeding,（ 1 ） the serum HBV- DNA level was declined in both groups, and it was lower in the ETV group at each time point than in the ADV group （ P 〈 0.05 ） ; （ 2 ） the proportion of patients with undetectable serum HBV- DNA was increased in both group in each time point, furthermore, the ETV group demonstrated a significant higher proportion than the ADV group at 24 weeks and 48 weeks; （3） the rate of HBeAg seroconversion was elevated in both groups, but there was no difference between the 2 groups at each time point ; （4） the serum level of ALT was declined in the 2 groups at each time point, although ETV group showed a significant reduction at the 24 weeks （P 〈 0.05 ）, but it was similar at all other time points. No side effect was observed in the 2 groups. Conclusion： ETV is more superior to ADV in suppressing the serum HBV-DNA, increasing the proportion of patients with undetectable serum HBV-DNA and rate of HBeAg seroconversion, as well as in decreasing the serum ALT in HBeAg（ ＋ ） CHB patients.