摘要
目的分析恩替卡韦(ETV)联合阿德福韦酯(ADV)与泰诺福韦酯(TDF)单药在急性加重期肝炎患者中的应用价值.方法入选100例HBeAg阳性急性加重期的患者.患者接受ETV 0.5mg/d加ADV 10mg/d(n=52)或泰诺福韦酯(TDF)单药300mg/d(n=48)治疗48周.每3个月进行一次肝肾功能、血清磷、HBV血清标志物、HBV DNA负荷和肝脏超声检查.采用t检验和χ^(2)检验比较两组的疗效、副作用.结果ETV+ADV组52例,TDF组48例,随访96周.ETV+ADV联合治疗组和TDF单药治疗组第48周HBV DNA检测不到率分别为76.9%和81.3%(P=0.631),第96周分别为92.3%和95.8%(P=0.679).ETV+ADV联合治疗组和TDF单药治疗组第48周血清谷丙转氨酶正常化率分别为84.6%和87.5%(P=0.777),第96周为92.3%和95.8%(P=0.679).但在第96周时,联合治疗组血清磷水平明显低于TDF单一治疗组(1.13±0.15 VS 1.22±0.16,P=0.004).结论ETV+ADV联合治疗和TDF单药治疗对阿德福韦耐药的慢性乙型肝炎均有效.然而,它与直到第96周的不良血清学反应有关.ETV(0.5mg/d)联合ADV(10mg/d)长期治疗乙型肝炎可能导致低磷血症和肾功能损害,因此需要定期监测血清磷酸盐、血清肌酐指标和评估表皮生长因子受体.
0bjective To analyze the clinical value of Entecavir(ETV)combined with Adefovir dipivoxil(ADV)and Tenofovir dipivoxil(TDF)inpatients with acute exacerbationepatitis.Method 100 patients with HBEAG positive inacute exacerbationstage were selected.Patients were treated with ETV 0.5 mg plus ADV 10 mg/day(n=52)or Tenofovir dipivoxil(TDF)300 mg/day(n=48)for 48 weeks.Liver and kidney function,serum phosphorus,HBV Serum Markers,HBV DNA load and liver ultrasound were examined every 3 months.Ttest and χ^(2) test were used to compare the curative effect and side effect betweenthe two groups.Result 52 cases in ETV+ADV group and 48 cases in TDF group were followed up for 96 weeks.The undetectable rate of HBV DNA was 76.9%and 81.3%(P=0.631)inETV+ADV combined group and TDF monotherapy group at 48 weeks,and 92.3%and 95.8%respectively at 96 weeks(P=0.679).The ALANINE transaminase rate of ETV+ADV Group and TDF group at 48 weeks was 84.6%and 87.5%respectively(P0777),and that of 96 weeks was 92.39%and 95.8%respectively(P=0.679).But at the 96th week,the serum phosphorus level inthe combined group was signifcantly lower thanthat inthe TDF group(1.13+0.15 VS 1.22±0.16,P=0.004).Conc lus ion ETV+ADV combinationtherapy and TDF monotherapy are effective for chronic hepatitis B with adefovir resistance.However,it was associated with adverse serological reactions up to week 96.Long-term treatment of hepatis B with ETV(0.5 mg/day)and ADV(10 mg/day)may lead to hypophosphatemia and impaired renal function,which requires regular monitoring of serum phosphate,serum creatinine and assessment of EGFR.
作者
王冰
Wang Bing(Yingtan People's Hospital,Jiangxi,Yingtan 335000)
出处
《首都食品与医药》
2022年第13期53-55,共3页
Capital Food Medicine
