摘要目的 比较恩替卡韦与替比夫定对慢性乙型病毒性肝炎(chronic hepatitis B,CHB)患者治疗的临床疗效.方法 将100例CHB患者随机分为两组,每组50例.恩替卡韦组患者给予恩替卡韦分散片治疗,替比夫定组患者给予替比夫定片治疗,比较两组患者在用药后12、24和108周时HBV DNA不可测率、较基线下降(＞103 copies/ml)率、血清谷丙转氨酶(ALT)复常率、HBeAg消失率和HBeAg/HBeAb的转换率,Child-Pugh评分变化及不良反应发生情况.结果 两组患者在24、108周时HBV DNA不可测率与12周相比具有显著性差异(P＜0.05).在108周时,患者的较基线下降率与12周相比具有显著性差异(P＜0.05).在12周时,替比夫定组HBeAg消失率和HBeAg/HBeAb转换率与恩替卡韦组比较有统计学差异(P＜0.05).经108周治疗后,就Child-Pugh评分来讲,两组患者肝脏储备功能达A级的人数对比治疗前具有显著性差异(P＜0.05),并且替比夫定组比恩替卡韦组肝脏储备功能达A级的人数多,两组比较有统计学差异(P＜0.05).结论 替比夫定和恩替卡韦对HBV DNA均具有较强的抑制作用,可以有效抑制病毒复制.替比夫定在临床治疗慢性乙型病毒性肝炎的优势主要体现在较快提高HBeAg/HBeAb转换率、改善Child-pughp评分.因此,替比夫定可作为CHB患者的推荐治疗药物.

abstractsObjective To compare the clinical efficacy of entecavir and telbivudine for chronic hepatitis B (CHB).Methods One hundred 100 CHB patients were randomly divided into two groups with 50 subjects in each group.The entecavir treatment group was treated with entecavir dispersible tablet and the telbivudine treatment group was treated with telbivudine tablet.The clinical index were compared for the undectable rate of HBV DNA,the proportion of HBV DNA decreased,the recovery rate of alanine aminotransferase (ALT),the disappearance rate of HBeAg,the conversion rate of HBeAg/HBeAb,Child-Pugh score changes and adverse reactions were compared at 12,24 and 108 weeks.Results The undectable rates of HBV DNA at 24 and 108 weeks showed significant difference comparing to the data in 12 weeks in the two groups (P ＜0.05).The proportions of HBV DNA decreased in the two groups in 108 week also showed significant difference comparing to the data in 12 weeks (P ＜ 0.05).At 12 weeks,the disappearance rate of HBeAg and the conversion rate of HBeAg/HBeAb showed significant differences between Entecavir and Telbivudine treatment groups (P ＜0.05).For Child-Pugh score,after 108 weeks of treatment,the number o grade A subjects in telbivudine treatment group were higher than that of the Entecavir treatment group (P ＜0.05).Conclusions Both entecavir and telbivudine have strong inhabitation effects on HBV-DNA and can stop the virus replications effectively.Telbivudine shows the advantage of more early increasing in the conversion rate of HBeAg/HBeAb and improvement in the Child-Pugh score.Therefore,telbivudine is recommended in the treatment of CHB.