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目的对比观察恩替卡韦单药与拉米夫定及阿德福韦酯联合治疗慢性乙型肝炎的疗效。方法选择2013年2月—2016年2月收治的慢性乙型肝炎患者146例,随机分为单药组与联合组各73例。单药组单纯给予恩替卡韦治疗,0.5 mg/次。联合组给予拉米夫定100 mg/次,阿德福韦酯10 mg/次联合治疗。两组均1次/d,治疗48周。对比两组治疗12、24、36、48周ALT复常率、HBV DNA阴转率及HBeAg转阴率。ALT复常率、HBV DNA阴转率、HBeAg转阴率比较采用χ~2检验,P<0.05为差异有统计学意义。结果单药组治疗12、24、36、48周ALT复常率分别为47.95%、61.64%、78.08%、95.89%,联合组分别为49.32%、73.97%、95.89%、100.00%;治疗36周ALT联合组复常率高于单药组(P<0.05)。单药组治疗12、24、36、48周HBV DNA阴转率分别为49.32%、53.42%、60.27%、91.78%,联合组分别为53.42%、84.93%、97.26%、97.26%;治疗36、48周联合组HBV DNA阴转率高于单药组(均P<0.05)。单药组治疗12、24、36、48周HBeAg转阴率分别为0、4.11%、10.96%、17.81%,联合组分别为0、8.22%、17.81%、27.40%。两组治疗12、24、36、48周HBeAg转阴率比较差异无统计学意义(均P>0.05)。结论恩替卡韦单药与拉米夫定及阿德福韦酯联合治疗慢性乙型肝炎均有良好的疗效,但联合用药ALT复常、HBV DNA阴转时间早。
Objective To compare the efficacy of entecavir monotherapy with lamivudine and adefovir in the treatment of chronic hepatitis B. Methods A total of 146 patients with chronic hepatitis B who were admitted from February 2013 to February 2016 were randomly divided into single drug group (n = 73) and combination group (n = 73). The single drug group was given entecavir alone, 0.5 mg / time. The combination group received lamivudine 100 mg / time and adefovir dipivoxil 10 mg / time. Two groups were 1 / d, for 48 weeks. The ALT normalization rate, HBV DNA negative conversion rate and HBeAg negative conversion rate were compared between the two groups at 12, 24, 36 and 48 weeks. ALT normalization rate, HBV DNA negative conversion rate, HBeAg negative conversion rate using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results The rates of ALT at 12, 24, 36 and 48 weeks after treatment were 47.95%, 61.64%, 78.08% and 95.89% respectively in the single drug group and 49.32%, 73.97%, 95.89% and 100.00% respectively in the combined group; ALT combined group had higher normalization rate than that of single drug group (P <0.05). The negative conversion rate of HBV DNA in the monotherapy group was 49.32%, 53.42%, 60.27% and 91.78% at the 12th, 24th, 36th, and 48th weeks, respectively. The combined group was 53.42%, 84.93%, 97.26% and 97.26% The HBV DNA negative conversion rate in the 48-week combined group was higher than that in the single drug group (all P <0.05). The negative rates of HBeAg in the monotherapy group were 0, 4.11%, 10.96% and 17.81% at 12, 24, 36, and 48 weeks respectively, while those in the combined group were 0, 8.22%, 17.81% and 27.40%, respectively. There was no significant difference in HBeAg negative rates between the two groups at 12, 24, 36 and 48 weeks (all P> 0.05). Conclusions Entecavir monotherapy combined with lamivudine and adefovir dipivoxil has a good curative effect in treating chronic hepatitis B. However, combined treatment of ALT normalization and HBV DNA negative conversion time is earlier.