CAJ | 학술논문

目的比较IFNα-2b(安福隆)与阿德福韦酯(贺维力)用于初治HBeAg阳性慢性乙型肝炎(慢乙肝)2年疗效、患者耐受性和治疗成本.方法对门诊治疗的慢乙肝初治患者,根据患者意愿决定初治药物:34例患者选择重组人IFNα-2b 500万U,隔日1次皮下注射;43例患者予以阿德福韦酯10 mg/d,口服.当治疗无效或因不良反应不能耐受时,根据患者的意愿停药或改变治疗方案,随访24个月.评价两种药物初选治疗的疗效、不良反应、依从性及治疗成本.数据行Fisher精确概率检验.结果治疗12个月时,34例IFN初治组和43例阿德福韦酯初治组患者HBV DNA＜500拷贝/mL分别为9例和29例,各占26.5%和67.4%;ALT复常各有14例和40例,分别占41.2%和93.0%(P＜0.01);HBeAg转阴率和HBeAg血清学转换率两组差异无统计学意义.IFN初治组中途脱落8例,占23.5%,3例患者因不良反应中断治疗,16例患者中途改变治疗药物;而阿德福韦酯初治组治疗2年间未发现与药物有关或可能有关的不良反应,患者耐受性好,中途脱落3例,占7.0%,4例患者中途改变治疗(P＜0.01).两组患者治疗成本比较显示,IFN初洽组抗病毒治疗、治疗不良反应和实验室检测的费用均高于阿德福韦酯初治组,2年人均费用增加4855元.结论对HBeAg阳性慢乙肝患者,阿德福韦酯作为初治首选药物可能是目前较经济合理的一种选择.
목적 비교IFNα-2b(안복륭)여아덕복위지(하유력)용우초치HBeAg양성만성을형간염(만을간)2년료효、환자내수성화치료성본.방법 대문진치료적만을간초치환자,근거환자의원결정초치약물:34례환자선택중조인IFNα-2b 500만U,격일1차피하주사;43례환자여이아덕복위지10 mg/d,구복.당치료무효혹인불량반응불능내수시,근거환자적의원정약혹개변치료방안,수방24개월.평개량충약물초선치료적료효、불량반응、의종성급치료성본.수거행Fisher정학개솔검험.결과 치료12개월시,34례IFN초치조화43례아덕복위지초치조환자HBV DNA＜500고패/mL분별위9례화29례,각점26.5%화67.4%;ALT복상각유14례화40례,분별점41.2%화93.0%(P＜0.01);HBeAg전음솔화HBeAg혈청학전환솔량조차이무통계학의의.IFN초치조중도탈락8례,점23.5%,3례환자인불량반응중단치료,16례환자중도개변치료약물;이아덕복위지초치조치료2년간미발현여약물유관혹가능유관적불량반응,환자내수성호,중도탈락3례,점7.0%,4례환자중도개변치료(P＜0.01).량조환자치료성본비교현시,IFN초흡조항병독치료、치료불량반응화실험실검측적비용균고우아덕복위지초치조,2년인균비용증가4855원.결론 대HBeAg양성만을간환자,아덕복위지작위초치수선약물가능시목전교경제합리적일충선택.
Objective To compare the efficacy, tolerance and cost of interferon (IFN) α-2b and adefovir (ADV) in patients with chronic hepatitis B (CHB) for two years. Methods The treatmentnaive outpatients with CHB were treated with IFN α-2b or ADV according to intention to treat.Among 77 patients, 34 were treated with recombinant IFN α-2b 5 MU once every other day subcutaneously (IFN group), 43 were treated with ADV 10 mg/day orally (ADV group). The medications were stopped or the regimens were changed due to intolerant adverse reactions or without effects according to intention to treat. The patients were followed up for 24 months. The therapeutic effects, adverse reactions, compliance and cost of two initial treatments were compared. The data were analyzed by Fisher exact probability test. Results The complete virological response (HBV DNA＜500 copy/mL) rates after 12 months of therapy in IFN group and ADV group were 41.2% (14/34)and 67. 4 % (29/43), respectively, while the alanine aminotransferase (ALT) normalization rates were41.2% (14/34) and 93. 0% (40/43), respectively. The rates in ADV group were both significantly greater than those in IFN group (both P＜0.01). There were no statistically significant differences of HBeAg negative rate and HBeAg seroconversion rate between the two groups. In IFN group, the expulsion rate was 23. 5% (8/34), the therapy was discontinued in 8. 8% (3/34) of patients due to adverse reactions and the medication was changed in 47.1% (16/34) of patients. In ADV group, there were no adverse reactions associated with medication during 2-year therapy and patients were well tolerant, the expulsion rate was 7.0% (3/43) and the regimen in 9.3% (4/43) of patients was changed (P＜0.01). The comparison of therapeutic cost between the two groups showed that the cost of anti-viral therapy, management with adverse reactions and laboratory examinations in IFN group were all higher than those in ADV group. The average cost per person of two years was increased with RMB 4855 yuan in IFN group. Conclusion In HBeAg-positive CHB patients, ADV is cost-effective and suitable choice for initial antiviral treatment.