目的 比较替比夫定与恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者24周疗效及安全性.方法 将60例HBeAg阳性慢性乙型肝炎患者随机分为替比夫定组和恩替卡韦组,比较两组治疗第12周和24周的疗效.结果 在治疗12周时,两组患者HBV DNA低于检测水平和ALT复常率相比较,差异无统计学意义(P>0.05),替比夫定治疗组HBeAg阴转率和HBeAg血清学转换率高于恩替卡韦组(36.7%对14.3%,26.7%对6.7%,P<0.05);在治疗24周时,两组HBV DNA低于检测水平、ALT复常率、HBeAg血清学转换率相比较,差异均无统计学意义(P>0.05),而替比夫定组HBeAg阴转率高于恩替卡韦组(P<0.05);多因素Logistic回归分析发现仅基线ALT水平高的患者更易出现HBeAg血清学转换.结论 替比夫定和恩替卡韦治疗CHB患者疗效相当,但替比夫定治疗患者HBeAg阴转率稍高于恩替卡韦治疗.%Objective To evaluate the efficacy and safety of telbivudine and entecavir in the treatments of patients with HBeAg-positive chronic hepatitis B (CHB). Methods Sixty HBeAg -positive CHB patients were divided into telbivudine-and entecavir-treated group. The efficacy and safety of the two groups were assessed at 12 and 24 weeks. Results There were no significant differences in the rates of normalization of ALT and of HBV DNA undetectable between the two groups at week 12 and 24 (P＞0.05) ;the loss and seroconversion rate of HBeAg at week 12 were significantly higher in the telhivudine group than in the entecavir group (36.7％ vs. 14.3％ and 26.7％vs. 6.7％,P＜0.05);there was no significant difference in the seroconversion rate of HBeAg between the two groups at week 24,but there was significant difference in the clearance rate of HBeAg between the two groups (46.7％vs.20.0％,P＜0.05);The high baseline ALT levels was the independent factor related to HBeAg seroconversion at week 24 in both groups. Conclusion Telbivudine and entecavir are both effective for treatment of patients with CHB,and serum HBeAg seroconversion rate in telbivudine group i.s higher than in entecavir group.
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