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目的对比观察替比夫定(Ld T)联合阿德福韦酯(ADV)治疗青年高病毒载量乙型肝炎e抗原(HBe Ag)阳性慢性乙型病毒性肝炎(CHB)的疗效。方法 106例HBe Ag阳性、HBV DNA≥107拷贝/m L的青年CHB初治患者分为替比夫定(Ld T)联合阿德福韦酯(ADV)联合治疗组(54例)和恩替卡韦(ETV)对照组(52例)。联合治疗组口服Ld T 600 mg/d+ADV 10 mg/d,1次/d;对照组口服ETV 0.5 mg/d,1次/d。总疗程48周,观察两组患者治疗12、24、36、48周时乙型病毒性(HBV)DNA阴转率、HBe Ag血清学转换率及丙氨酸氨基转移酶(ALT)的复常率。结果治疗后,两组患者均取得较好的疗效,获得较高的HBV DNA转阴率和ALT复常率。在治疗第12、24、36、48周时两组的HBV DNA阴转率及ALT复常率比较,差异均无统计学意义;但联合治疗组HBe Ag血清学转换率24周后明显高于ETV对照组(33.3%vs 13.5%,χ2=5.804、P=0.016),差异有统计学意义,且36周和48周统计学差异更加显著(42.6%vs 15.4%,χ2=9.477、P=0.002;48.1%vs 19.2%,χ2=9.877、P=0.002)。结论替比夫定联合阿德福韦酯治疗青年高病毒载量的初治HBe Ag阳性CHB患者,不仅获得较高的病毒学应答率和肝功能复常率,与恩替卡韦相比还能获得更高的HBe Ag血清转换率。
Objective To compare the efficacy of telbivudine (Ld T) and adefovir dipivoxil (ADV) in the treatment of young patients with high viral load of hepatitis B e antigen (HBe Ag) -positive chronic hepatitis B (CHB). Methods A total of 106 young patients with positive HBeAg and HBV DNA≥107 copies / m L were divided into three groups: treatment with Ld T combined with adefovir dipivoxil (ADV) and entecavir ETV) control group (52 cases). The combination therapy group was given Ld T 600 mg / d + ADV 10 mg / d once a day, while the control group was given ETV 0.5 mg / d once daily. The total course of treatment was 48 weeks. The negative conversion rate of HBV DNA, the seroconversion rate of HBeAg and the normalization rate of alanine aminotransferase (ALT) were observed at 12, 24, 36 and 48 weeks after treatment. Results After treatment, the two groups of patients achieved better curative effect and achieved higher rates of HBV DNA negative conversion and ALT normalization. There was no significant difference in the HBV DNA negative rate and ALT normalization rate between the two groups at the 12th, 24th, 36th and 48th week of treatment. However, HBeAg seroconversion rate in the combined treatment group was significantly higher than that at 24 weeks ETV control group (33.3% vs 13.5%, χ2 = 5.804, P = 0.016), the difference was statistically significant, and statistical difference was more significant at 36 weeks and 48 weeks (42.6% vs 15.4%, χ2 = 9.477, P = 0.002 ; 48.1% vs 19.2%, χ2 = 9.877, P = 0.002). CONCLUSIONS: Telbivudine combined with adefovir dipivoxil in treatment of newly diagnosed HBeAg-positive CHB patients with high viral load in young patients not only achieved a higher rate of virological response and normalization of liver function, but also obtained more High HBeAg seroconversion rate.