摘要
目的:观察和比较替比夫定、拉米夫定对慢性乙型肝炎患者的疗效以及对血清乙肝抗原蛋白水平的影响。方法:采用1∶1随机、对照设计。共入组慢性乙型肝炎患者100例,随机分为替比夫定组50例,拉米夫定组50例;对照观察两组临床疗效及不良反应;并动态监测患者血清HBsAg、HBeAg水平的变化。结果:治疗1年时,替比夫定组患者血清HBV DNA PCR法检测不到的比率、ALT复常率均较拉米夫定组稍高,但无统计学意义;HBeAg阴转率及血清学转化率以及病毒突破率分别为34%、28%和8%,均优于拉米夫定组的16%、12%和22%,差异均有显著性意义(P分别为0.0377、0.0455和0.0498)。两组患者治疗后血清抗原蛋白HBsAg及HBeAg水平均有不同程度的下降,但替比夫定组患者治疗1个月时,血清HBsAg和HBeAg水平较基线下降分别为(30.2±16.1)S/N和(80.8±12.9)S/CO,均高于拉米夫定组的(7.8±12.4)S/N和(10.9±27.9)S/CO,差异有统计学意义;至治疗12个月时,其降幅差异更为明显,分别达到(146.7±32.5)S/N和(202.3±62.8)S/CO及(68.4±39.5)S/N和(90.4±52.8)S/CO,差异有非常显著的统计学意义;替比夫定不良反应轻微,与拉米夫定类似。结论:替比夫定较拉米夫定具有更强地抑制HBV DNA复制能力以及较少的耐药率和病毒反跳率;同时替比夫定能更强地抑制病毒抗原蛋白的表达,可能与较高的HBeAg血清学转换率有关。
Objective：To observe and compare the efficacy of telbivudine and lamivudine in patients with chronic hepatitis B and their effects on the serum protein levels of hepatitis B antigen.Methods：With 1∶1 randomized,controlled design,a total of 100 patients with chronic hepatitis B were enrolled and randomly divided into the telbivudine group of 50 patients and 50 patients with lamivudine group.The clinical efficacy and adverse reactions of the two groups were observed in control,and dynamics of serum HBsAg,HBeAg levels were monitored and compared .Results：One year of treatment,the negative rate of semm HBV DNA levels（ PCR-undetectable ,1000 copies/ml）,and ALT normalization rate in telbivudine group was slightly higher than the lamivudine group,but there were no statistical significance;HBeAg serum negative rates and conversion rates and viral breakthrough rate were 34%,28% and 8%,better than the lamivudine group with 16%,12% and 22%,respectively,the difference had statistically significance（P=0.0377,0.0455 and 0.0498,respectively）.After the begining of treatment,serum HBsAg and HBeAg had different levels of decline,but in treatment 1 month, the level of serum HBsAg and HBeAg in telbivudine treatment group decreased from with baseline were （30.2±16.1） S / N,and （80.8±12.9） S / CO higher than the lamivudine group （7.8±12.4） S/ N,and （10.9±27.9）S / CO,the difference had statistically significance（P=0.005 and 0.05 respectively）.To treatment 12 months,its decline was more difference obviously,respectively （146.7±32.5）S / N,（202.3±62.8） S/CO and （68.4±39.5）S/N,（90.4±52.8）S/CO（P=0.000 and 0.000 respectively）,the differences had more statistically significance .For telbivudine,adverse reactions were mild,similar to lamivudine.Conclusion：Telbivudine is significant superior to lamivudine with respect to strong suppression of HBV DNA replication and less resistance to the nucleosides as well as viral breakthrough.While telbivudine to stronger inhibition of virus a
出处
《中西医结合肝病杂志》
CAS
2010年第3期138-140,192,共4页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
