CAJ | 학술논문

目的：观察替比夫定治疗慢性乙型肝炎的疗效及不良反应并评估影响疗效的因素。方法采用替比夫定600 mg/日口服治疗75例HBeAg阳性的慢性乙型肝炎患者，根据治疗24周时HBV DNA是否低于检测下限将所有患者分为A组和B组，根据基线ALT水平将所有患者分为2～5倍ULN组及＞5倍ULN组，根据基线HBD DNA水平将所有患者分为中低载量组（105拷贝/ml ≤ HBV DNA＜107拷贝/ml）及高载量组（≥107拷贝/ml），分别计算治疗24周、48周、96周患者的ALT复常率、HBV DNA低于检测下限的比率、HBeAg血清转换率并进行比较分析。结果 A组和B组患者替比夫定治疗48周时的ALT复常率、HBV DNA低于检测下限的比率、HBeAg血清转换率分别为97.2% vs 66.7%、100% vs 33.3%、52.8% vs 12.1%（P ＜0.05），治疗96周时A组与B组相比分别为94.4% vs 66.7%、97.2%vs 48.7%、55.6%vs 12.1%（P＜0.05）；基线ALT 2～5倍ULN组和＞5倍ULN组治疗96周时的ALT复常率、HBV DNA低于检测下限的比率、HBeAg血清转换率分别为77.8% vs 82.1%、58.3%vs 84.6%、19.4%vs 43.4%；基线HBV DNA中低载量组和高载量组治疗96周时的ALT复常率、HBV DNA低于检测下限的比率、HBeAg血清学转换率分别为75%vs 81.4%、87.5%vs 60.5%、53.1%vs 16.3%。结论替比夫定可迅速抑制HBV DNA复制，患者发生ALT复常、HBeAg血清学转换的比率较高，治疗24周HBV DNA下降幅度能较好预测治疗第48周、96周的疗效。
목적：관찰체비부정치료만성을형간염적료효급불량반응병평고영향료효적인소。방법채용체비부정600 mg/일구복치료75례HBeAg양성적만성을형간염환자，근거치료24주시HBV DNA시부저우검측하한장소유환자분위A조화B조，근거기선ALT수평장소유환자분위2～5배ULN조급＞5배ULN조，근거기선HBD DNA수평장소유환자분위중저재량조（105고패/ml ≤ HBV DNA＜107고패/ml）급고재량조（≥107고패/ml），분별계산치료24주、48주、96주환자적ALT복상솔、HBV DNA저우검측하한적비솔、HBeAg혈청전환솔병진행비교분석。결과 A조화B조환자체비부정치료48주시적ALT복상솔、HBV DNA저우검측하한적비솔、HBeAg혈청전환솔분별위97.2% vs 66.7%、100% vs 33.3%、52.8% vs 12.1%（P ＜0.05），치료96주시A조여B조상비분별위94.4% vs 66.7%、97.2%vs 48.7%、55.6%vs 12.1%（P＜0.05）；기선ALT 2～5배ULN조화＞5배ULN조치료96주시적ALT복상솔、HBV DNA저우검측하한적비솔、HBeAg혈청전환솔분별위77.8% vs 82.1%、58.3%vs 84.6%、19.4%vs 43.4%；기선HBV DNA중저재량조화고재량조치료96주시적ALT복상솔、HBV DNA저우검측하한적비솔、HBeAg혈청학전환솔분별위75%vs 81.4%、87.5%vs 60.5%、53.1%vs 16.3%。결론체비부정가신속억제HBV DNA복제，환자발생ALT복상、HBeAg혈청학전환적비솔교고，치료24주HBV DNA하강폭도능교호예측치료제48주、96주적료효。
Objective To evaluate the efifcacy of telbivudine on patients with chronic hepatitis B (CHB) and to explore the influencing factors. Methods Total of 75 HBeAg-positive CHB patients with HBeAg-positive were treated with telbivudine 600 mg per time, once a day for 96 weeks. After telbivudine treatment for 24 weeks, patients with undetectable HBV DNA were distributed as group A (n=36), while patients with detectable HBV DNA were distributed as group B (n = 39). According to the baseline ALT levels, patients were divided into two groups (2-5 × ULN group, n = 36; > 5 × ULN group, n = 39). According to the baseline HBV DNA level, all patients were divided into a low DNA load group (105 copies/ml≤ HBV DNA<107 copies/ml, n=32) and a high DNA load group (HBV DNA≥107 copies/ml, n=43) . For 24, 48 and 96 weeks of patients with the recovery rate of ALT, HBV and DNA below the lower limit of detection rate and HBeAg seroconversion rates were calculated and compared in the above two groups. Results The rates of ALT normalization, HBV DNA undetectable and HBeAg/anti-HBeAg seroconversion were 97.2%vs 66.7%, 100%vs 33.3%, 52.8%vs 12.1%(P<0.05), in group A and group B after telbivudine treatment for 48 weeks, respectively, and which were 94.4%vs 66.7%, 97.2%vs 48.7%, 55.6%vs 12.1%(P<0.05). In group A and group B after the treatment for 96 weeks, respectively. In the group of 2-5 × ULN and > 5 × ULN which were 77.8%vs 82.1%, 58.3%vs 84.6%and 19.4%vs 43.4%after telbivudine treatment for 96 weeks, respectively. The rates of ALT normalization, HBV DNA undetectable and HBeAg/anti-HBeAg seroconversion were 75%vs 81.4%, 87.5%vs 60.5%, 53.1%vs 16.3%in low and high DNA load group at baseline after telbivudine treatment for 96 weeks, respectively. Conclusions Telbivudine could rapidly inhibit HBV replication and improve the ALT normalization and HBeAg/anti-HBeAg seroconversion. HBV DNA decline after telbivudine treatment for 24 weeks was a good predict value for the efifcacy of telbivudine treatment for 48 weeks and 96 weeks.