恩替卡韦与拉米夫定治疗e抗原阳性慢性乙型肝炎的疗效对比

摘要

Objective To investigate the effect of entecavirand lamivudine in treatment of HBeAg-positive chronic hepatitis B,so as to provide bases for the initial treatment of HBeAg-positive chronic hepatitis B patients with appropriate treatment. Methods 155 patients with HBeAg-positive chronic hepatitis B were randomly divided into 2 groups:entecavir group(79 cases) and lamivudine group(76cases) according to the method of treatment;ALT normalization rates at different treatment time points were recorded, HBeAg seroconversion and the number of the patients with HBV-DNA below the detection value were compared.Results The ALT normalization rates of the entecavir group in 3,6 months of treatment were 36.7%and 75.9%,the lamivudinegroup 38.2%and 75.0%, the differences were not statistically significant;after the treatment for 12 months,ALT levels were all back to normal;the negative rates of HBV-DNA in entecavir group were 29.1%,51.9%,77.2%and 78.5%in the 3,6,12 and 24 months treatment,the lamivudinegroup 19.7%,32.9%,48.7% and 39.5%, the differences were statistically significant;the negative rates of HBeAg in entecavir group were 0,5.1%,22.8%and 36.7%in the 3,6,12 and 24 months treatment,the lamivudinegroup 0,2.6%,17.1%and 26.3%, the differences were statistically significant,too.Conclusion Although there is no statistically difference in the ALT normalization rates, the effect of entecaviris better than lamivudine in the incidence of HBeAg negative and the incidence of HBV-DNA below the detection value forHBeAg-positive chronic hepatitis B.%目的：分析恩替卡韦与拉米夫定治疗e抗原阳性慢性乙型肝炎患者疗效的差异,为e抗原阳性慢性乙型肝炎初治患者提供合理的治疗方案。方法选择e抗原阳性慢性乙型肝炎患者155例,随机分为2组：恩替卡韦组79例和拉米夫定组76例。均治疗24个月,对比不同治疗时间点两组ALT复常率、HBeAg转阴率及HBV-DNA转阴率。结果恩替卡韦组在治疗第3、6个月时ALT复常率为36.7%、75.9%,拉米夫定组为38.2%、75.0%,两组差异无统计学意义,治疗12个月后两组ALT均恢复正常水平；治疗第3、6、12、24个月时,恩替卡韦组的HBV-DNA转阴率为29.1%、51.9%、77.2%,78.5%,拉米夫定组为19.7%、32.9%、48.7%,39.5%,两组差异有统计学意义(均P<0.01)；治疗第3、6、12、24个月时,恩替卡韦组HBeAg转阴率为0、5.1%、22.8%、36.7%,拉米夫定组为0、2.6%、17.1%、26.3%,两组有差异有统计学意义(均P<0.01)。两组均未发现严重的不良反应。结论恩替卡韦与拉米夫定治疗e抗原阳性慢性乙型肝炎在肝酶复常率方面差异无统计学意义,但在HBeAg转阴率及HBV-DNA转阴率方面的疗效恩替卡韦明显优于拉米夫定。