摘要
目的观察富马酸丙酚替诺福韦(TAF)对恩替卡韦(ETV)治疗后低病毒血症的慢性乙型肝炎患者的疗效。方法选取2019年3月—2020年10月在武汉市金银潭医院经ETV抗病毒治疗的慢性乙型肝炎患者160例,经倾向评分匹配分为试验组和对照组各80例。试验组换用TAF抗病毒治疗,对照组继续ETV治疗,持续治疗24周。观察2组患者治疗后HBV DNA阴转率、HBeAg阴转率、ALT水平、肾小球滤过率(eGFR)、FIB-4值、肝硬度值变化及药物不良反应发生情况。计量资料2组间比较采用t检验,计数资料2组间比较采用χ^(2)检验。结果治疗24周后,试验组HBV DNA阴转率较对照组明显升高(96.25%vs 16.25%,χ^(2)=104.03,P<0.001),HBeAg阴转率较对照组明显升高(34.78%vs 11.90%,χ^(2)=6.32,P<0.05)。试验组ALT、eGFR、FIB-4值及肝硬度值与对照组比较均有不同程度改善(t值分别为5.77、4.21、8.45、4.58,P值均<0.05),用药期间对照组及试验组的药物不良反应发生率分别为7.50%和8.75%,2组间差异无统计学意义(P>0.05)。结论对ETV经治后低病毒血症的慢性乙型肝炎患者,更换TAF抗病毒治疗能够有效提高低病毒血症患者的HBV DNA及HBeAg阴转率,并且能够明显改善患者肝肾功能、减轻肝纤维化程度,治疗安全性好。
Objective To investigate the clinical effect of tenofovir alafenamide fumarate(TAF)on chronic hepatitis B(CHB)patients with low-level viremia(LLV)after entecavir(ETV)treatment.Methods A total of 160 CHB patients who received ETV antiviral therapy in Wuhan Jinyintan Hospital from March 2019 to October 2020 were enrolled and divided into experimental group and control group by propensity score matching,with 80 patients in each group.The patients in the experimental group were given TAF antiviral therapy,and those in the control group were given ETV treatment;the course of treatment was 24 weeks for both groups.The two groups were compared in terms of HBV-DNA clearance rate,HBeAg clearance rate,alanine aminotransferase(ALT)level,estimated glomerular filtration rate(eGFR),FIB-4 value,liver stiffness measurement,and adverse drug reactions after treatment.The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Results After 24 weeks of treatment,compared with the control group,the experimental group had significantly higher HBV DNA clearance rate(96.25%vs 16.25%,χ^(2)=104.03,P<0.001)and HBeAg clearance rate(34.78%vs 11.90%,χ^(2)=6.32,P<0.05).Compared with the control group,the experimental group had varying degrees of improvement in ALT,eGFR,FIB-4,and liver stiffness measurement(t=5.77,4.21,8.45,and 4.58,all P<0.05),and there was no significant difference in the incidence rate of adverse drug reactions between the control group and the experimental group during treatment(7.50%vs 8.75%,P>0.05).Conclusion For CHB patients with LLV after ETV treatment,the change to TAF antiviral therapy can effectively increase their HBV DNA clearance rate and HBeAg clearance rate,improve liver and renal function,and reduce the degree of liver fibrosis,with good safety.
作者
程海林
胡旭东
夏冰
柏涛
卢斯霞
CHENG Hailin;HU Xudong;XIA Bing;BAI Tao;LU Sixia(Department of Gastroenterology,Wuhan Jinyintan Hospital,Wuhan 430023,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2022年第3期537-540,共4页
Journal of Clinical Hepatology
基金
武汉市卫生与计划生育委员会科研课题(WX17D19)。
