替诺福韦酯单药治疗慢性乙型肝炎的临床效果
2019-04-21张敏
张敏
【摘要】 目的:探讨替诺福韦酯单药治疗慢性乙型肝炎的临床效果。方法:密集抽样法选取2015年3月-2018年3月笔者所在医院收治的64例慢性乙型肝炎患者。按照随机数字表法将其分为两组,各32例。对照组给予恩替卡韦单药治疗,研究组给予替诺福韦酯单药治疗。比较两组临床疗效。结果:治疗6、12个月时,研究组HBV DNA转阴率分别为68.75%、93.75%,均高于对照组的40.63%、56.25%,差异有统计学意义(字2=5.107、12.000,P=0.023、0.000)。治疗6、12个月时,研究组ALT复常率分别为71.88%、96.88%,均高于對照组的43.75%、62.50%,差异有统计学意义(字2=5.189、11.680,P=0.022、0.000)。研究组不良反应发生率为6.25%,低于对照组的28.13%,差异有统计学意义(字2=5.379,P=0.020)。结论:慢性乙型肝炎采用替诺福韦酯单药治疗效果显著,可提升HBV DNA转阴率、ALT复常率,改善肾功能,且不良反应少,值得临床推广。
【关键词】 慢性乙型肝炎 替诺福韦酯 恩替卡韦
doi:10.14033/j.cnki.cfmr.2019.29.005 文献标识码 A 文章编号 1674-6805(2019)29-00-03
[Abstract] Objective: To investigate the clinical efficacy of Tenofovir Disoproxil alone in the treatment of chronic hepatitis B. Method: A total of 64 patients with chronic hepatitis B admitted in our hospital from March 2015 to March 2018 were selected by intensive sampling method. According to the random number table method, they were divided into two groups, with 32 cases in each group. The control group was treated with Entecavir monotherapy, while the study group was treated with Tenofovir Disoproxil monotherapy. The efficacy of the two groups was compared. Result: At 6 and 12 months of treatment, the HBV DNA negative conversion rates in the study group were 68.75% and 93.75%, respectively , which were higher than 40.63% and 56.25% in the control group, the differences were statistically significant (字2=5.107, 12.000, P=0.023, 0.000). At 6 and 12 months of treatment, the ALT recurrence rates in the study group were 71.88% and 96.88%, respectively, which were higher than 43.75% and 62.50% in the control group, the differences were statistically significant (字2=5.189, 11.680, P=0.022, 0.000). The incidence of adverse reactions in the study group was 6.25%, which was lower than 28.13% in the control group, the difference was statistically significant (字2=5.379, P=0.020). Conclusion: Tenofovir Disoproxil monotherapy for chronic hepatitis B has a significant therapeutic effect, which can improve the rate of HBV DNA negative conversion and ALT recurrence, improve renal function, and have fewer adverse reactions, which is worthy of clinical promotion.
[Key words] Chronic hepatitis B Tenofovir Disoproxil Entecavir
First-authors address: General Hospital of Xuzhou Mining Group, Xuzhou 221000, China
近年来,慢性乙型肝炎逐渐发展成为严重威胁人们身心健康、生活质量的重要疾病之一,全球范围内发病率、病死率均较高[1]。该病主要由乙型肝炎病毒(HBV)感染所致,若不及时治疗,可导致出现一系列重症疾病,包括肝功能衰竭、肝硬化等[2]。该病还具有一定传染性,且传染途径较多,如血液、体液等。故需强化早期防治力度,选择恰当治疗方案,切实改善患者预后。目前,临床多采用抗病毒药物治疗,包括恩替卡韦、替诺福韦酯、阿德福韦酯等。其中替诺福韦酯属于单磷酸腺苷类似物,被各国指南推荐为慢性乙型肝炎抗病毒首选一线药物之一,但临床就其治疗中单用时效果及安全性仍存在较大争议[3]。本次研究在32例慢性乙型肝炎患者治疗中单用替诺福韦酯,获得理想效果,现报道如下。
本次研究局限之处在于所选病例数较少,且研究指标不够全面,研究时间短,覆盖地区范围小。故今后仍需加大研究力度,进行更深层次调查分析,证实慢性乙型肝炎治疗中替诺福韦酯单药应用价值。
综上所述,替诺福韦酯单药治疗慢性乙型肝炎可达到理想效果,且不良反应少,值得进行深入研究和推广。
参考文献
[1]世界卫生组织.慢性乙型肝炎病毒感染预防、关怀和治疗指南[J].中国病毒病杂志,2015,5(5):342-346.
[2]陈红英,丁洁,游晶.慢性乙型肝炎病毒感染者血清流行病学研究[J].中国全科医学,2017,20(8):939-942.
[3]刘黄巧,何清,唐奇远,等.单用替诺福韦酯与恩替卡韦联合阿德福韦酯挽救治疗慢性乙型肝炎对比观察[J].中西医结合肝病杂志,2017,27(5):284-285.
[4]中华医学会肝病学分会.慢性乙型肝炎防治指南(2015年版)[J/OL].中华实验和临床感染病杂志:电子版,2015,19(5):1-18.
[5]王平贵,张晓曙,安婧,等.甘肃省1~59岁人群乙型肝炎血清流行病学特征分析[J].中华预防医学杂志,2018,52(10):1056.
[6]赵龙凤,王艳.临床一线抗病毒药物对慢性乙型肝炎治疗结局的影响[J].中华肝脏病杂志,2017,25(7):485.
[7]郭琴芳,眭静,叶云,等.E抗原阳性慢性乙型肝炎患者干扰素抗病毒药物依从性的影响因素[J].江苏医药,2017,43(2):94-97.
[8]李忠斌,邵清,李梵,等.替诺福韦酯单独与联合恩替卡韦挽救治疗恩替卡韦治疗拉米夫定经治慢性乙型肝炎失败患者疗效比较[J].肝脏,2016,21(3):165-167.
[9]李忠斌,邵清,李梵,等.拉米夫定和阿德福韦酯初始联合与替诺福韦酯单药治疗慢性乙型肝炎48周疗效和安全性比较[J].医学研究杂志,2016,45(4):105-108.
[10]夏六均,趙维群,黄浩.替诺福韦酯联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎临床疗效及影响因素分析[J].实用医院临床杂志,2018,15(4):210-213.
[11]颜悦蓉,冯继红.替诺福韦酯治疗核苷和核苷酸类药物耐药慢性乙型肝炎患者的研究进展[J].临床肝胆病杂志,2016,32(11):2182-2185.
[12]李红艺,朱倩钰,任江波,等.长期应用替诺福韦酯治疗对慢性乙型肝炎患者肾功能的影响[J].临床和实验医学杂志,2018,17(12):29-32.
(收稿日期:2019-05-21) (本文编辑:桑茹南)