Objective To evaluate the efficacy of a 36 - month telbivudine (LdT) treatment regimen in patients with hepatitis B e antigen (HBeAg) -positive chronic hepatitis B (CHB) and to explore the predictive factors of LdT -induced HBeAg seroconversion using logistic regression analysis. Methods A total of 58 HBeAg - positive CHB patients treated with LdT continuously for 36 months were analyzed to determine any potential correlations between sex, age, baseline levels of alanine aminotransferase (ALT), HBV DNA load, HBeAg titer, or hepatitis B surface antigen (HBsAg) titer and end — of - treatment rates of ALT normalization, undetectable HBV DNA, HBeAg clearance, or HBeAg seroconversion. The factors capable of predicting HBeAg seroconversion were identified by logistic regression analysis. Results After 36 months of LdT treatment, the ALT normalization rate was 84.48% , the undetectable HBV DNA rate was 70.69% , the HBeAg clearance rate was 50.0% , and the HBeAg seroconversion rate was 43.1%. The undetectable HBV DNA rate was significantly correlated to baseline HBV DNA load (P <0.05). The HBeAg clearance rate was significantly correlated to baseline HBeAg titers and HBV DNA load (P < 0.05). The HBeAg seroconversion rate was significantly correlated to baseline ALT, HBeAg titers, and HBV DNA load (P<0.05). However, all of these indicators were unrelated to sex, age, or baseline HBsAg titers (P >0.05). Multivariate logistic regression analysis showed that only the patients with lower baseline HBeAg titer were more likely to develop HBeAg seroconversion. Conclusion Continuous LdT treatment over 36 months can effectively improve liver function, suppress HBV replication, and increase the HBeAg seroconversion rate. Baseline HBeAg titer may be a useful predictive factor of the HBeAg seroconversion rate in HBeAg - positive CHB patients who are treated with LdT.%目的 观察替比夫定(LdT)治疗HBeAg阳性慢性乙型肝炎(CHB)患者3年的疗效,应用Logistic回归探讨HBeAg血清学转换的预测因子.方法 收集58例采用LdT治疗的HBeAg阳性CHB患者,分析其性别、年龄、基线ALT水平、基线HBV DNA载量、基线HBeAg和HBsAg滴度与治疗3年时ALT复常率、HBV DNA阴转率、HBeAg阴转率和HBeAg血清转换率的相关性；采用Logistic回归分析HBeAg血清转换的相关因素.结果 治疗3年时ALT复常率为84.48％,HBV DNA阴转率为70.69％,HBeAg阴转率为50.00％,HBeAg血清转换率为43.10％.与ALT≤2倍正常值上限(2×ULN)相比,基线ALT＞5×ULN的患者HBeAg转换率显著增高(P＜0.05)；与HBeAg≤100(S/CO)组相比,基线HBeAg＞ 200 S/CO的患者HBeAg的阴转率和血清转换率均显著下降(P＜0.05)；与HBV DNA≤6 log拷贝/ml组相比,HBV DNA＞7 log拷贝/ml的患者HBV DNA转阴率、HBeAg转阴率和HBeAg转换率下降显著(P＜0.05)；患者性别、年龄及基线HBsAg滴度对以上疗效指标无影响(P＞0.05).多因素Logistic回归分析发现仅基线HBeAg滴度低的患者更易出现HBeAg血清学转换.结论 LdT能有效恢复肝功能,抑制HBV复制和提高HBeAg血清转换；基线HBeAg滴度可预测LdT治疗HBeAg阳性CHB患者的HBeAg血清转换率.
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