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目的观察核苷类似物治疗慢性乙型肝炎病毒学及血清学的变化,探讨核苷类似物停用的时间及其安全性。方法 95例慢性乙型肝炎患者,口服核苷类似物6年,出现HBV DNA反弹的患者,根据测耐药位点,换用或联合核苷类似物,定期检查生化学指标、乙肝两对半定量、HBV DNA定量变化。结果 6年中拉米夫定(LAM)、阿德福韦酯(ADV)、恩替卡韦(ETV)、替比夫定(TBV)、LAM+ADV和ETV+ADV组的HBV DNA阴转时间分别为(9.3±2.7)、(12.7±2.9)、(4.5±2.1)、(8.9±2.6)、(4.8±1.9)、(3.8±0.9)月,ADV组时间最长,低于其他组,差异具有统计学意义(P<0.05);随着HBeAg载量的增高,HBeAg阴转时间和血清转换时间延长(P<0.05)。结论对高病毒载量的慢性乙型肝炎患者核苷类似物使用应在6年以上,此类患者治疗达标后应适当延长疗程,巩固疗效。
Objective To observe the changes of virological and serological changes of nucleoside analogues in treatment of chronic hepatitis B and to explore the time and safety of nucleoside analogue withdrawal. Methods Ninety-five patients with chronic hepatitis B who received nucleoside analogues for 6 years were enrolled in this study. Patients with HBV DNA rebound appeared to be biochemically tested for two or a half Quantitative, HBV DNA quantitative changes. Results The HBV DNA negative time of lamivudine (LAM), adefovir dipivoxil (ADV), entecavir (ETV), telbivudine (TBV), LAM + ADV and ETV + ADV group were (9.3 ± 2.7), (12.7 ± 2.9), (4.5 ± 2.1), (8.9 ± 2.6), (4.8 ± 1.9) and (3.8 ± 0.9) months respectively. (P <0.05). With the increase of HBeAg load, the time of HBeAg negative conversion and the time of seroconversion were prolonged (P <0.05). Conclusion The use of nucleoside analogues in patients with chronic hepatitis B virus with high viral load should be used for more than 6 years. Such patients should be appropriately extended course of treatment after treatment to achieve the goal of consolidating the therapeutic effect.