替诺福韦酯治疗40例恩替卡韦疗效不慢性乙型肝炎患者临床分析.docVIP

替诺福韦酯治疗40例恩替卡韦疗效不佳慢性乙型肝炎患者临床分析 　　[摘要] 目的 探讨替诺福韦酯（TDF）对恩替卡韦（ETV）效果不佳的慢性乙型肝炎（CHB）患者的临床疗效。 方法 采用TDF对40例ETV效果不佳的CHB患者进行挽救治疗，每天300 mg口服，连续48周。分析第12、24、48周时HBV DNA转阴率、病毒学突破率、ALT复常率、HBeAg血清学转换率及不良反应发生率。 结果 基线时点、第12、24、48周HBV DNA转阴率分别为0%、40.0%、72.5%、92.5%（各时间点病毒学突破率均为0），ALT复常率分别为10.0%、37.5%、62.5%、90.0%，两指标各时间点前后比较，差异均有统计学意义（P0.05）。 结论 TDF挽救治疗ETV效果不佳的CHB患者是一种有效、安全的优化治疗方案。 中国论文网 /6/viewhtm　　[关键词] 替诺福韦酯；挽救治疗；恩替卡韦；治疗失败；慢性乙型肝炎 　　[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701（2017）35-0102-03 　　[Abstract] Objective To investigate the clinical efficacy of tenofovir disoproxil fumarate（TDF） in patients with chronic hepatitis B（CHB） with poor response to entecavir（ETV）. Methods 40 patients with CHB with poor response to ETV were given salvage therapy by TDF. They were orally given 300 mg TDF daily for 48 weeks continuously. Afterwards， HBV DNA negative turning rate， virological breakthrough rate， ALT normalization rate， HBeAg seroconversion rate and incidence of adverse reactions were analyzed at week 12， week 24 and week 48. Results At baseline， the negative turning rates of HBV DNA at week 12， 24 and 48 were 0%， 40.0%， 72.5%， 92.5% respectively（virological breakthrough rates at all time points were 0）， and ALT normalization rates were 10.0%， 37.5%， 62.5%， 90.0% respectively. The two indicators were compared before and after each time point， and the differences were statistically significant（P0.05）. Conclusion TDF salvage therapy is an effective and safe optimized treatment protocol for CHB patients with poor response to ETV. 　　[Key words] Tenofovir disoproxil fumarate（TDF）； Salvage therapy； Entecavir（ETV）； Treatment failure； Chronic hepatitis B 　　慢性乙型肝炎（chronic hepatitis B，CHB）是?乐匚：?广大人民健康的传染性疾病，抗乙肝病毒（hepatitis B virus，HBV）治疗能有效减少传染性，改善肝功能，延缓晚期肝病的发生。在目前抗HBV药物中，替诺福韦酯（tenofovir disoproxil fumarate，TDF）和恩替卡韦（entecavir，ETV）是一线强效抗病毒药物[1，2]。然而，近年来，随着核苷（酸）类药物种类增多及多种不规范的序贯或联合治疗方案的应用，导致 ETV应答不佳或耐药的患者越来越多。目前，专家共识建议，对于 ETV治疗失败的患者，可换用或加用TDF的治疗方案[3]，由于国内相关报道较少，本文对TDF单用治疗40例ETV疗效不佳患者的情况进行