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探讨耐阿德福韦酯HBeAg阳性慢性乙型肝炎(NADV-CHB)患者采用恩替卡韦进行挽救治疗48周过程中的临床疗效及安全性。随机选取巴中市中心医院感染科门诊在2012年5月至2015年5月收治NADV-CHB患者62例作为研究对象,用恩替卡韦进行挽救治疗。对挽救治疗前及治疗48周后血清HBVDNA、丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)及总胆红素(TBIL)水平,治疗后6、12、24、36、48周血清HBV-DNA和HBeAg的阴转率,ALT、AST、TBIL的复常率以及挽救治疗过程中的药物不良反应的进行回顾性分析。结果显示,挽救治疗48周后血清HBV-DNA、ALT、AST及TBIL水平较挽救治疗前下降,差异均有统计学意义(t=26.51、14.53、8.67、13.26,P=0.007、0.004、0.008、0.009);血清HBV-DVA和HBeAg转阴率和ALT、AST和TBIL复常率较挽救治疗6周时提高,差异有统计学意义(t=32.35、7.12、5.12、17.68、17.84,P=0.025、0.019、0.042、0.011、0.043);挽救治疗期间未发现病毒学突破,无严重不良反应发生。恩替卡韦能有效控制NADV-CHB患者的HBV复制,可提高血清HBV-DNA和HBeAg的转阴率以及降低ALT、AST和TBIL复常率,不良反应少,安全性好,值得推广。
To investigate the clinical efficacy and safety of adefovir dipivoxil in HBeAg-positive chronic hepatitis B (NADV-CHB) patients treated with entecavir for 48 weeks. A total of 62 patients with NADV-CHB were enrolled from May 2012 to May 2015 in Bazhong Central Hospital Infectious Diseases Clinic as study subjects, and entecavir was used for salvage therapy. The levels of serum HBV DNA, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) before treatment and after 48 weeks of treatment, 48 weeks of serum HBV-DNA and HBeAg negative conversion rate, ALT, AST, TBIL normalization rate and salvage treatment of adverse drug reactions were retrospectively analyzed. The results showed that the levels of serum HBV-DNA, ALT, AST and TBIL decreased significantly after rescue treatment for 48 weeks (t = 26.51,14.53,8.67,13.26, P = 0.007,0.004,0.008, 0.009). The rates of serum HBV-DVA and HBeAg negative conversion and ALT, AST and TBIL were higher than those of salvage treatment at 6 weeks after salvage treatment (t = 32.35,7.12,5.12,17.68,17.84, P = 0.025) , 0.019,0.042,0.011,0.043); no virological breakthrough was found during salvage treatment and no serious adverse reactions occurred. Entecavir can effectively control HBV replication in patients with NADV-CHB, which can increase the negative conversion rate of serum HBV-DNA and HBeAg and reduce the normalization rate of ALT, AST and TBIL with less adverse reactions and good safety.