目的 观察对不规范停用恩替卡韦后复发的乙肝患者再次应用恩替卡韦进行抗病毒治疗的临床效果.方法 选择感染科治疗后复发的乙肝肝硬化患者32例为试验组,同时选择同期治疗的40例确诊并初次治疗的乙肝肝硬化患者作为对照组.2组患者均进行口服恩替卡韦分散片进行抗病毒治疗.进行的随访观察,于确诊治疗后1、3、6个月时观察患者生化复常率、乙肝病毒DNA转阴率、血清HBeAg转换率及耐药性检测.结果 试验组患者生化复常率水平在各监测点明显低于对照组,在1、3、6个月时检测结果差异有统计学意义(P<0.05).2组患者乙肝病毒DNA转阴率,试验组明显高于对照组,差异有统计学意义(P<0.05).试验组患者血清 HBeAg阳性转阴率、血清HBeAg滴度50%降低率明显高于对照组(P<0.05).2组患者均未检测到耐药菌株出现.结论 对不规范停用恩替卡韦后复发的乙肝肝硬化患者再次应用恩替卡韦进行抗病毒治疗与初治者相比,患者的肝功能炎性反应重,复治时使用恩替卡韦安全性较好,肝功能恢复良好.%Objective To observe the the rapeutic effects of entecavir administration again on recurrent hepatitis B because of irregular discontinuation of entecavir. Methods Thirty-two patients with recurrent hepatitis B liver cirrhosis were enrolled as experimental group,at the same time,the other 40 patients with hepatitis B liver cirrhosis who were treated firstly in our department from July 2014 to July2017 were enrolled as control group.The patients in both groups were given orally entecavir dispersible tablets for antiviral therapy,with 6-month follow up,and the biochemical normalization rate,hepatitis B virus DNA negative rate,HBeAg seroconversion rate and drug resistance at 1m,3m,6m were observed and compared between two groups.Results The biochemical recurrence rates at 1m,3m,6m in experimental group were significantly lower than those in control group (P<0.05).The HBV DNA negative rate in experimental group was significantly higher than that in control group (P<0.05). Moreover the HBeAg positive seroconversion rate,serum titer of HBeAg 50% decrease rate in experimental group were significantly higher than those in control group (P<0.05).Besides no drug resistant strain was detected in both groups. Conclusion The entecavir administration again in treatment of recurrent hepatitis B because of irregular discontinuation of entecavir can obviously improve patient's liver function,with safety,however,the inflammatory reaction of liver function of patients is severe,as compared with that of patients who are treated firstly.
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