替比夫定治療乙肝e抗原陽性慢性乙型肝炎患者的療效及預測因素的分析_《華西醫學》

作者：

畢紅霞 , 趙倩 ,  雷學忠 , 雷秉鈞

四川大學華西醫院感染性疾病中心（成都，610041）;

關鍵詞：

乙型肝炎預測價值替比夫定乙肝e抗原

DOI：

10.7507/1002-0179.20130124

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目的　探討替比夫定治療乙肝e抗原（HBeAg）陽性慢性乙型肝炎（CHB）患者72周的療效及預測因素的分析。方法　選擇2007年9月－2012年9月符合入選標準的82例CHB患者接受替比夫定治療72周，于治療前基線、治療后每3個月查丙氨酸氨基轉移酶（ALT）、乙肝病毒DNA（HBV DNA）、乙肝病毒血清標志物，觀察治療期間累計生化學應答率、完全病毒學應答率(CVR)、HBeAg血清學轉換率（SR）及耐藥率，分析基線ALT水平[分為＜5 ULN（正常值檢測下限）組及≥5 ULN組]、HBV DNA水平（分為＜107 copies/mL組及≥107 copies/mL組）、24周HBV DNA水平（＜3 log 10 copies/mL組及≥3 log 10 copies/mL組），預測72周CVR及SR。結果　172周累計生化學應答率、CVR、SR、耐藥率分別為86.6%、81.7%、42.7%、18.2%；2基線ALT≥5 ULN對72周SR有預測價值（χ2=5.651，P=0.017），HBV DNA＜107 copies/mL對CVR有預測價值（χ2=7.083，P=0.008）；324周HBV DNA＜103 copies/mL對72周CVR及SR均有預測價值（χ2=27.339，5.131；P=0.000，0.023）。結論　替比夫定初治HBeAg陽性CHB患者療效及安全性好，治療24周HBV DNA＜103 copies/mL是72周療效的最佳預測指標。

引用本文： 畢紅霞,趙倩,雷學忠,雷秉鈞. 替比夫定治療乙肝e抗原陽性慢性乙型肝炎患者的療效及預測因素的分析. 華西醫學, 2013, 28(3): 391-394. doi: 10.7507/1002-0179.20130124 復制

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1. 　World Health Organization: The World Health Report 1997[EB/OL]. Available at http://www.who.int/whr/1997/en/index.html.
2. 　Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States:recommendations of the Advisory Committee on Immunization Practices(ACIP)part1: immunization of infants,children,and adolescents[J]. MMWR Recomm Rep, 2005, 54(RR-16): 1-31.
3. 　Lok AS. Chronic hepatitis B[J]. N Engl J Med, 2002, 346(22): 1682-1683.
4. 　中華醫學會肝病學分會, 中華醫學會感染病學分會. 慢性乙型肝炎防治指南[J]. 中國病原生物學雜志, 2011, 6(1): 67-77.
5. 　賈繼東, 侯金林, 尹有寬, 等. 替比夫定或拉米夫定抗乙型肝炎病毒的療效預測探討[J]. 中華肝臟病雜志, 2007, 15(5): 342-345.
6. 　Liaw YF, Gane E, Leung N, et al. 2-Year GLOBE trial results:telbivudine is superior to lamivudine in patients with chronic hepatitis B[J]. Gastroenterology, 2009, 136(2): 486-495.
7. 　European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B[J]. J Hepatol, 2009, 50(2): 227-242.
8. 　Duong A, Mousa SA. Current status of nucleoside antivirals in chronic hepatitis B[J]. Drugs Today (Barc), 2009, 45(10): 751-761.
9. 　Lau GK. Current treatments for patients with HBeAg-positive chronic hepatitis B virus infection: a comparison focusing on HBeAg seroconversion[J]. Liver Int, 2010, 30 (4): 512-520.
10. 　Zeuzem S, Gane E, Liaw YF, et al .Baseline characteristics and early on-treatment response predict the outcomes of 2 years of telbivudine treatment of chronic hepatitis B[J]. J Hepatol, 2009, 51(1): 11-20.
11. 　白鵠, 梅存金, 胡茂平, 等. 替比夫定對HBeAg 抗原陽性慢性乙肝ALT 水平與HBeAg 血清轉換關系的影響[J]. 齊齊哈爾醫學院學報, 2009, 30(24): 3080-3081.
12. 　Yuen MF, Fong DY, Wong DK, et al. Hepatitis B virus DNA lecels at week 4 of lamivudine treatment predict the 5-year ideal response[J]. Hepatology, 2007, 46(6): 1695-1703.
13. 　Keefe EB, Zeuzem S, Koff RS, et al. Report of an international workshop:Roadmap for management of patients receiving oral therapy for chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2007, 5(8): 890-897.

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替比夫定治療乙肝e抗原陽性慢性乙型肝炎患者的療效及預測因素的分析

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替比夫定治療乙肝e抗原陽性慢性乙型肝炎患者的療效及預測因素的分析

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