Objective To evaluate the efficacy and safety of sequential nucleoside analogues therapy following interferon failure on patients with HBeAg-positive chronic hepatitis B.Methods One hundred and ten HBeAg-positive CHB patients were divided into telbivudine-treated and entecavir-treated group.The efficacy and safety of the two groups were assessed during a thirty-six months period.Results After thirty-six months,there were no significant differences in the proportion of ALT normalization and HBV DNA undetectable rate between the two groups.The seroconversion rate of HBeAg at 6,12,18,24,30,36 months were significantly higher in the telbivudine group than in the entecavir group (21.2％ vs.9.1％,33.3％vs.13.6％,36.4％ vs.14.3％,38％ vs.13.3％,40.5％ vs.17.4％,55.3％ vs.31.2％,P ＜ 0.05).rtM204I Mutation was found 7 patients in telbivudine group and 0 in entecavir group,respectively.No apparent adverse effects were found in both groups.Conclusion Sequential nucleoside analogue therapy is effective for treatment of interferon failure patients with higher and faster biochemical response and virological response,and serum HBeAg seroconversion rate in telbivudine group is higher than that in entecavir group.%目的 探讨核苷类似物对干扰素治疗疗效欠佳的HBeAg阳性慢性乙肝患者的治疗效果.方法 选择干扰素治疗疗效欠佳的HBeAg阳性慢性乙肝患者共110例,序贯使用核苷类似物抗病毒治疗,分为LdT序贯治疗组和ETV序贯治疗组,随访3年观察患者的肝功能、血清学和病毒学应答、不良反应和耐药情况.结果 经过3年的随访,两组均获得较高的肝功能复常率和HBV DNA转阴率,两组比较均无显著性差异.治疗6、12、18、24、30、36个月时,LdT序贯治疗组的HBeAg血清学转换率分别为21.2％、33.3％、36.4％、38％、40.5％、55.3％,ETV序贯治疗组的HBeAg血清学转换率分别为9.1％、13.6％、14.3％、13.3％、17.4％、31.2％,LdT序贯治疗组HBeAg血清学转换率在治疗后6个月至36个月明显高于ETV序贯治疗组,差异有统计学意义.LdT序贯治疗组有7例(10.6％)出现rtM204I位点变异,ETV序贯治疗组未发现耐药变异病例.两组均无明显不良反应发生.结论 干扰素治疗疗效欠佳的HBeAg阳性慢性乙肝患者序贯使用LdT或ETV,可获得较高的生化学和病毒学应答,LdT序贯治疗组3年内的HBeAg血清学转换率优于ETV序贯治疗组.
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