论文部分内容阅读
目的观察替比夫定(LDT)优化治疗对HBeAg阳性慢性乙型肝炎患者的疗效及安全性。方法选择基线HBV DNA<109copies/ml、ALT>2 ULN的45例HBeAg阳性慢性乙型肝炎患者,给予LDT600 mg/d治疗。4、12、24、52周时分别检测HBV DNA、HBeAg和肝功能。24周时HBV DNA≥500 copies/ml者,加阿德福韦酯10 mg/d联合;HBV DNA<500 copies/ml者,继续单服替比夫定。结果 45例中44例治疗52周以上,4、12、24、52周时HBV DNA检测率分别0、17.8%、66.7%和82.2%;ALT复常率分别为17.8%、57.8%、77.8%和95.6%;HBeAg血清转阴率分别为0、13.3%、28.9%和57.8%。另外1例因严重不良反应而换用恩替卡韦治疗。总耐药率及严重不良反应率分别为4.44%和2.22%。结论临床应用LDT治疗HBeAg阳性慢性乙肝患者,通过基线的筛选及在治疗24周时根据HBV DNA水平,联合阿德福韦酯优化治疗,则52周能取得较好的疗效及安全性。
Objective To observe the efficacy and safety of optimized treatment of telbivudine (LDT) in patients with HBeAg-positive chronic hepatitis B. Methods Forty-five HBeAg-positive chronic hepatitis B patients with baseline HBV DNA <109 copies / ml and ALT> 2 ULN were given 600 mg / d LDT. HBV DNA, HBeAg and liver function were detected at 4, 12, 24 and 52 weeks respectively. 24 weeks HBV DNA ≥ 500 copies / ml, plus adefovir dipivoxil 10 mg / d combination; HBV DNA <500 copies / ml who continue telbivudine single. Results Of the 45 cases, 44 cases were treated for more than 52 weeks. The detection rates of HBV DNA were 0,17.8%, 66.7% and 82.2% at 4, 12, 24 and 52 weeks respectively. The rates of ALT recovery were 17.8%, 57.8% and 77.8% And 95.6%, respectively; HBeAg seroconversion rates were 0, 13.3%, 28.9% and 57.8% respectively. Another case of serious adverse reactions and switched to entecavir treatment. Total resistance rate and serious adverse reaction rate were 4.44% and 2.22% respectively. Conclusions The clinical application of LDT in the treatment of HBeAg-positive chronic hepatitis B patients, through the baseline screening and treatment of 24 weeks based on HBV DNA levels, combined with adefovir dipivoxil optimized treatment, 52 weeks can achieve better efficacy and safety.