论文部分内容阅读
目的探讨基于替诺福韦酯(TDF)的联合治疗对既往核苷(酸)类似物(NAs)应答不佳/耐药的慢性乙型肝炎(CHB)患者的临床疗效。方法对NAs应答不佳/耐药的CHB患者予以入组,给予以TDF为基础的抗病毒治疗,一组为NAs组,给予TDF+拉米夫定(LAM)、TDF+恩替卡韦(ETV);另一组为干扰素(IFN)组,给予TDF+IFN、TDF+LAM+IFN、TDF+ETV+IFN。预计疗程48~96周。比较两组患者抗病毒的疗效。结果入组68例(NAs组41例,IFN组27例)患者基线耐药检测阳性率为77.9%。治疗48周,NAs组和IFN组乙肝病毒(HBV)DNA下降分别为(3.52±2.42)lg IU/ml、(3.62±1.29)lg IU/ml(P=0.832),HBV DNA转阴(<20 IU/ml)率分别为73.1%、96.3%(P=0.043)。IFN组较NAs组e抗原(HBe Ag)下降更明显[(1.07±1.30)lg COI vs.(0.35±0.98)lg COI,P=0.017]。NAs组和IFN组表面抗原(HBs Ag)下降分别为(0.09±0.61)lg IU/ml、(0.54±1.05)lg IU/ml(P=0.015)。48~96周的延长疗程中NAs组和IFN组分别有1例、3例患者出现HBs Ag转阴。结论以TDF为基础的联合治疗方案可有效抑制病毒复制;在HBe Ag及HBs Ag转阴/转换率方面,IFN组更具优势。
Objective To investigate the clinical efficacy of combination therapy with tenofovir disoproxil (TDF) in patients with chronic hepatitis B (CHB) who had poor response to previous nucleos (s) analogues (NAs). Methods CHB patients with poor response to NAs were enrolled in this study. TDF-based antiviral therapy was used. One group was NAs, and TDF + lamivudine (LAM) and TDF + entecavir (ETV) Group was interferon (IFN) group, given TDF + IFN, TDF + LAM + IFN, TDF + ETV + IFN. The expected course of 48 to 96 weeks. Compare the anti-virus efficacy of two groups of patients. Results The positive rate of baseline drug resistance in 68 patients (41 in NAs group and 27 in IFN group) was 77.9%. After 48 weeks of treatment, the DNA of HBV DNA in NAs group and IFN group decreased (3.52 ± 2.42) lg IU / ml, (3.62 ± 1.29) lg IU / ml IU / ml) rates were 73.1% and 96.3%, respectively (P = 0.043). The decrease of e antigen (HBe Ag) in IFN group was more significant than that in NAs group [(1.07 ± 1.30) lg COI vs. (0.35 ± 0.98) lg COI, P = 0.017]. The decrease of surface antigen (HBsAg) in NAs group and IFN group were (0.09 ± 0.61) lg IU / ml and (0.54 ± 1.05) lg IU / ml, respectively. In the extended course of 48-96 weeks, there was 1 case of NAs and IFN respectively, and 3 cases of HBs Ag turned negative. Conclusions TDF-based combination therapy can effectively inhibit viral replication; the IFN group is more advantageous in terms of the negative conversion rate of HBeAg and HBsAg.