恩替卡韦治疗慢性乙型肝炎患者早期出现ALT一过性升高的临床意义

摘要/Abstract

摘要： 目的探讨恩替卡韦初治慢性乙型肝炎患者早期出现ALT升高的临床意义。方法选取 2015年1月至2016年10月住院的恩替卡韦初治的慢性乙型肝炎患者86 例,其中出现ALT升高的28例设为A组,未出现ALT升高的58例设为B组,比较两组患者抗病毒治疗24、48、96周的ALT复常率、HBsAg下降幅度、HBV DNA及HBeAg转阴率。结果治疗24周,A、B组的HBV DNA转阴率分别为75.0%、51.7%,A、B组的HBsAg下降幅度分别为0.47(0.19,0.52)、0.25(0.07,0.41) lg IU/mL,差异有统计学意义(P<0.05);治疗48周,A、B组的HBV DNA转阴率分别为89.3%、67.2%,A、B组的HBsAg下降幅度分别为0.62(0.27,0.74)、0.32(0.11,0.47) lg IU/mL,差异有统计学意义(P<0.05);治疗96周,A、B组HBsAg下降幅度分别为0.69(0.30,0.99)、0.36(0.20,0.60) lg IU/mL,A、B组HBsAg水平分别为(3.30±0.29)、(3.48±0.44) lg IU/mL,差异有统计学意义(P<0.05);其余各时间段其他指标,两组比较差异无统计学意义。组内比较,两组内各项指标均较前明显改善。结论恩替卡韦治疗慢性乙型肝炎患者早期出现一过性ALT升高者,可能促进了HBV DNA的清除及HBsAg水平的下降。

关键词: 慢性乙型肝炎, 恩替卡韦, ALT, HBV DNA, HBsAg, HBeAg, 免疫激活

Abstract: Objective To investigate the difference in the efficacy of entecavir between treatment-na?ve hepatitis B envelope antigen (HBeAg)-positive chronic hepatitis B (CHB) patients with and without alanine aminotransferase (ALT) elevation in the early treatment.Methods Eighty-six CHB patients initially treated with entecavir in our hospital from January 2015 to October 2016 were selected. Among them, 28 patients with ALT elevation were in group A, and 58 patients without ALT elevation were in group B, The ALT normalization rate, hepatitis B virus deoxyribonucleic acid (HBV DNA) negative conversion rate, hepatitis B surface antigen (HBsAg) decline and HBeAg negative conversion rate were compared between the 2 groups at week 24,48 and 96 of antiviral therapy. Results At week 24 of treatment, in group A and B, the HBV DNA conversion rates were 75.0% and 51.7%, the HBsAg declines were 0.47 lg IU/mL (0.19-0.52 lg IU/mL) and 0.25 lg IU/mL (0.07-0.41 lg IU/mL), the differences were both statistically significant (P<0.05). At week 48, in group A and B, the HBV DNA conversion rates were 89.3% and 67.2%, the HBsAg declines were 0.62 lg IU/mL (0.27-0.74 lg IU/mL) and 0.32 lg IU/mL (0.11-0.47 lg IU/mL), the differences were both statistically significant (P<0.05). At week 96, in group A and B, the HBsAg declines were 0.69 lg IU/mL (0.30-0.99 lg IU/mL) and 0.36 lg IU/mL (0.20-0.60 lg IU/mL), the level of HBsAg were 3.30 ± 0.29 lg IU/mL and 3.48 ± 0.44 lg IU/mL, the differences were both statistically significant (P<0.05). While, there was no statistical difference in other indicators in other time periods between the 2 groups. Moreover, within the group, the indicators in both groups were significantly ameliorated.Conclusion ALT transient elevation in early entecavir treatment may accelerate HBV DNA clearance and HBsAg decline.

Key words: Entecavir, Chronic hepatitis B, Alanine aminotransferase, Hepatitis B virus deoxyribonucleic acid, Hepatitis B surface antigen, Hepatitis B envelope antigen, Immune activation

赵晶晶, 韩方正. 恩替卡韦治疗慢性乙型肝炎患者早期出现ALT一过性升高的临床意义[J]. 肝脏, 2019, 24(6): 628-630.

ZHAO Jing-jing, HAN Fang-zheng. Clinical Study of transient ALT elevation in patients with chronic hepatitis B in the early stage of entecavir treatment[J]. Chinese Hepatolgy, 2019, 24(6): 628-630.

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恩替卡韦治疗慢性乙型肝炎患者早期出现ALT一过性升高的临床意义

Clinical Study of transient ALT elevation in patients with chronic hepatitis B in the early stage of entecavir treatment

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