Objective To evaluate the baseline serum HBeAg titers and its early negativity in predicting the efficacy of telbivudine (LdT) in the treatment of patients with HBeAg-positive chronic hepatitis B (CHB).Methods 58 patients with HBeAg positive CHB received LdT treatment for 36 months.Results The ALT normalization rate (94.8％)and HBV DNA undetective rate (84.5％) at month 12 were significantly higher than that at month 3(68.9％ and 65.5％,respectively,P＜0.05);the HBeAg negative rate(50.0％),HBeAg seroconversion rate (43.1％) and drug-resistance rate (29.3％) at month 36 were significantly higher than that at month 3(20.7％,17.2％ and 0.0％,respectively,P＜0.05)and month 6(25.9％,22.4％ and 1.7％,respectively,P＜0.05) ; baseline serum HBeAg titer and its early negativity predicted good efficacy at 36 months;when HBeAg≥300S/CO,it predicted high drug-resistance at 36 month treatment,with the sensitivity of 74.5％ and specificity of 78.0％.Conclusions LdT can effectively suppress HBV replication and improve HBeAg seroconversion,but high drug-resistance rate will occur for a long-term treatment.%目的 观察替比夫定(LdT)治疗HBeAg阳性慢性乙型肝炎(CHB)3年的疗效,筛选早期预测疗效的指标.方法 58例HBeAg阳性CHB患者接受LdT治疗3年.结果 在治疗12月时,血清ALT复常率和HBV DNA阴转率分别为94.8％和84.5％,而在治疗3月时分别为68.9％和65.5％；随着治疗时间延长,HBeAg阴转率、HBeAg/HBeAb血清转换率及耐药率均明显升高,至36月时分别达50.0％、43.1％和29.3％,而在治疗3月时分别为20.7％、17.2％和0.0％,6月时分别为25.9％、22.4％和1.7％；患者基线HBeAg滴度及疗程3月时HBeAg滴度下降幅度与治疗36月时HBeAg阴转率、HBeAg/HBeAb血清转换率及耐药率明显相关；基线HBeAg≥300S/CO时预测dT治疗3年后出现耐药的敏感性为74.5％,特异性为78.0％.结论 LdT能有效恢复肝功能,抑制HBV复制和提高HBeAg血清转换,但长时间使用后则耐药率较高；HBeAg基线水平及其下降幅度可早期预测LdT治疗HBeAg阳性CHB患者HBeAg血清转换率及耐药发生率.
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