关键词: 乙型肝炎, 慢性, 替诺福韦酯, 恩替卡韦, 耐药, 应答不佳

Abstract: Objective To investigate the clinical efficacy of Tenofovir dipivoxil (TDF) treatment on chronic hepatitis B patients with entecavir (ETV) resistance or poor-responsiveness.Methods Seventy chronic hepatitis B (CHB) patients collected from the 906th Hospital of Chinese PLA between March 2016 and April 2019 were enrolled in this retrospective case-control study. The patients were all poor responsiveness to initial ETV treatment. They were further divided into ETV poor-responsive group (group A, N=36) and ETV-resistance group (group B, N=44). All patients were shifted to TDF treatment alone for 48 weeks. The undetectable rate of HBV DNA, the alteration of liver and kidney function indexes, the incidence of adverse drug reactions were recorded and compared between these two groups after 12 weeks, 24 weeks, and 48 weeks of TDF treatment.Results (1) There was no significantly difference in gender, average age and average length between these two groups(P>0.05)(2)The undetectable rate of HBV DNA at 12 weeks in group A was 66.66%, which was significantly higher than that of 40.90% in group B (χ²=5.27, P=0.028<0.05). The undetectable rate of HBV DNA at 24 weeks and 48 weeks after TDF treatment in group A were 83.33%, and 94.44%, respectively, which were higher than those of 72.72%, and 86.36% in group B but didn’t reach significance (χ²=1.27,χ²=1.43; all P= 0.21:P>0.05)(3)Comparison of liver function recovery rate: at 12 weeks, the recovery rate in group A was 75.00% (12/16), which was significantly higher than that of 33.33% in group B: (8/24) (χ²=6.67,P=0.019<0.05). There were no significant differences between these two groups at weeks 24 and weeks 48 (P>0.05) (4) Adverse reactions: there were two cases had gastrointestinal reactions such as nausea and vomiting, and one case had a slight decrease in blood phosphorus. No obvious renal damage was observed in these patients within one year.Conclusion Significant antiviral efficacy and complete virus control can be achieved by TDF treatment in a short period of time. The treatment is efficient for ETV-resistance and poor-responsive patients for controlling viral replication, and delaying the progression and evolution of the disease.

Key words: Chronic hepatitis B, Tenofovir, Entecavir, Poor-responsiveness, Resistance