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目的:比较恩替卡韦初始单药与拉米夫定和阿德福韦酯联用对HBeAg阳性的慢性乙型肝炎(CHB)患者抗病毒的临床疗效。方法:选取2011年1月—2016年1月间收治的CHB患者70例,采用随机数字表法将其分为A组和B两组,每组35例;A组患者给予恩替卡韦治疗,B组患者给予拉米夫定和阿德福韦酯联用治疗,比较两组患者治疗12周、24周、36周及48周时,谷丙转氨酶(ALT)复常率、乙肝病毒基因(HBV-DNA)阴转率、HBeAg转阴率和耐药率,以及治疗期间不良反应的发生情况。结果:两组患者在治疗12周、24周及48周时的ALT复常率经比较其差异无统计学意义(P>0.05);治疗36周时A组患者ALT复常率明显高于B组(P<0.05);治疗12周和48周时,两组患者的HBV-DNA转阴率经比较其差异无统计学意义(P>0.05);治疗24周和36周时,A组患者的HBV-DNA转阴率明显高于B组(P<0.05);两组患者在治疗12周、24周、36周及48周时的HBeAg转阴率经比较其差异无统计学意义(P>0.05);两组患者在治疗期间均未见耐药和严重不良反应发生。结论:恩替卡韦初始单药与拉米夫定和阿德福韦酯初始联用治疗对HBeAg阳性CHB患者的临床疗效较佳,恩替卡韦初始单药治疗早期患者可出现ALT复常和HBV-DNA转阴。
OBJECTIVE: To compare the clinical efficacy of entecavir initial monotherapy with lamivudine and adefovir dipivoxil in the antiviral treatment of patients with HBeAg-positive chronic hepatitis B (CHB). Methods: Seventy patients with CHB admitted from January 2011 to January 2016 were enrolled in this study. They were divided into two groups (group A and group B, 35 cases) by random number table. Group A received entecavir treatment and group B Patients were treated with lamivudine and adefovir dipivoxil, the two groups of patients treated at 12 weeks, 24 weeks, 36 weeks and 48 weeks, alanine aminotransferase (ALT) normalization rate, hepatitis B virus gene (HBV- DNA) negative rate, HBeAg negative rate and drug resistance, as well as the incidence of adverse reactions during treatment. Results: There was no significant difference in ALT recovery between the two groups at 12 weeks, 24 weeks and 48 weeks (P> 0.05). At 36 weeks, ALT normalization rate in group A was significantly higher than that in group B (P <0.05). At 12 weeks and 48 weeks of treatment, the negative rates of HBV DNA in both groups had no significant difference (P> 0.05). At 24 weeks and 36 weeks, the patients in group A (P <0.05). There was no significant difference in HBeAg negative rate between the two groups at 12, 24, 36 and 48 weeks (P > 0.05). No drug resistance and serious adverse reactions occurred in both groups during the treatment. CONCLUSIONS: The initial combination of entecavir initial monotherapy with lamivudine and adefovir dipivoxil has a better clinical outcome in patients with HBeAg-positive CHB. Patients with early entecavir monotherapy may have abnormal ALT and HBV-DNA negative .