徐建明 1李兵 1游红勇 1宿冬远 2张玲 2李富宇 3周荣幸3
作者信息
- 1. 四川省崇州市人民医院普外科 611230
- 2. 四川省崇州市人民医院消化内科 611230
- 3. 四川大学华西医院胆道外科，成都610041
- 折叠
摘要
Abstract
Objective To compare the effect of the combination of entecavir (ETV) and tenofovir (TDF) with the combination of ETV and adefovir (ADV) in treatment of patients with chronic hepatitis B and lamivudine (LMD) resistance and to analyze the major prognostic influencing factors .Methods A total of 103 patients with chronic hepatitis B combined with LMD resistance in the hospital from May 2010 to November 2013 were selected as the subjects ,among which ,ETV combined with ADV were 51 cases and ETV combined with TDF were 52 cases .Age ,gender ,height ,weight ,body mass index (BMI) ,platelet ,alanine aminotransferase (ALT) ,total bilirubin ,albumin ,international normalized ratio (INR) (IQR) ,Child‐Pugh score ,positive cases of HBeAg ,DNA level of HBV ,cases of ADV resistant mutation in HBV ,cases of rtA181V/T variation ,cases of rtA181V/T and rtN236T mutation ,cases of ETV resistance mutation in HBV ,cases of rtS202G variation ,rtT184I/L/S variation ,rtM250V/L mutation ,cases of LAM ,ADV and ETV resistance mutation ,DNA reduction of patients with HBV from 3 to 12 months and virological response were analyzed . Results DNA reduction in the group of ETV combined with TDF (3 .14 ± 1 .58)log10 IU/mL was significantly higher than that in group of ETV combined with ADV (2 .31 ± 1 .84)log10 IU/mL (P<0 .05) .DNA reduction in the 12th month of ETV combined with TDF (3 .28 ± 1 .62)log10 IU/mL was significantly higher than that of group of ETV combined with ADV (2 .85 ± 1 .73)log10 IU/mL (P<0 .05) .The rates of virological response normally in the 6th ,9th and 12th month of the ETV combined with TDF group was significantly higher than of the ETV combined with ADV group (P< 0 .05) .Rates of ADV resistance mutation and rtA181V/T variation in the group of ETV combined with TDF were significantly higher than that of ETV combined with ADV (P<0 .05) .While the rate of ETV resistance mutation in group of ETV combined with TDF was significantly higher than that of ETV combined with ADV (P<0 .05) .DNA reduction of male patients was significantly higher than that of female patients in ETV combined with TDF group in the 12th month(P<0 .05) ,and the rates of virologitcal response of the male patients in the 6th and 9th month were significantly higher than that of female patients (P<0 .05) .Levels of DNA of HBV was the risk factor for the prognosis of patients with with chronic hepatitis B and lamivudine resistance (OR=0 .26 ,95% CI:0 .03-0 .64 ,P=0 .015) and the treatment of ETV combined with TDF was the protective factor (OR=98 .54 ,95% CI:75 .77 -323 .55 ,P=0 .001) .Conclusion TDF could inhibit the activity of the HBV better than ADV in the treatment of patients with chronic hepatitis B .For the patients with the decreased response for LAM and ADV ,TDF may be the effective alternative drug .关键词
慢性乙型肝炎/阿德福韦/恩替卡韦/替诺福韦/拉米夫定Key words
chronic hepatitis B/adefovir/entecavir/tenofovir/lamivudine
