恩替卡韦经治慢性乙型肝炎伴低病毒血症患者换用富马酸丙酚替诺福韦治疗的效果

摘要/Abstract

摘要： 目的分析恩替卡韦(ETV)治疗后出现低病毒血症(LLV)的慢性乙型肝炎(CHB)患者在更换富马酸丙酚替诺福韦(TAF)继续治疗的疗效情况。方法回顾性分析2022年1月—2023年12月于本院诊治的接受ETV治疗后出现LLV的CHB患者138例,依据患者是否更换方案分为ETV组(续用ETV,n=68)与TAF组(由ETV转换沿用TAF,n=70),比较两组治疗前后HBV标记物、肝肾功能水平变化,并分析治疗后完全病毒应答(CVR)率、HBeAg转阴率及ALT复常率。结果与入组时比,治疗后TAF组、ETV组治疗48周时HBV标记物HBV DNA、HBsAg均显著降低(P<0.05);与ETV组比,治疗48周时HBV标记物降低更为显著(P<0.05)。与入组时比,治疗后TAF组、ETV组治疗48周时肝功能均显著降低(P<0.05);与ETV组比,治疗48周时肝功能降低更为显著(P<0.05)。与入组时比,治疗后TAF组、ETV组治疗48周时血肌酐、β2-微球蛋白均显著降低,而eGFR明显提升(P<0.05);与ETV组比,治疗48周时肾功能改善更为显著(P<0.05)。治疗后TAF组CVR率、HBeAg转阴率显著高于ETV组(P<0.05),而两组ALT复常率比较不具有统计学意义(P>0.05)。结论 TAF在CHB患者的抗病毒疗效方面显示出显著优势,在病毒学完全抑制、HBeAg转阴、肝功能和肾功能改善方面优于ETV。

关键词: 慢性乙型肝炎, 低病毒血症, 恩替卡韦, 富马酸丙酚替诺福韦

Abstract: Objective To analyze the curative effect of switching treatment to tenofovir alafenamide fumarate (TAF) in chronic hepatitis B (CHB) patients with low-level viremia (LLV) after entecavir (ETV) treatment. Methods A retrospective analysis was conducted of 138 patients with CHB who were diagnosed and managed at our institution from January 2022 to December 2023. They were divided into ETV group (n=68) and TAF group (n=70) according to whether the patients continued to use ETV or switched to TAF. The changes of HBV markers, liver and kidney function levels before and after treatment were compared between the two groups, and the complete virological response (CVR) rate, the HBeAg negativity rate and ALT normalization rate were analyzed. Results After treatment, the HBV markers such as HBV DNA and HBsAg in TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with ETV group, HBV markers decreased more significantly after 48 weeks of treatment (P<0.05). After treatment, the liver function of TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with the ETV group, the liver function decreased significantly after 48 weeks of treatment (P<0.05). After treatment, the serum creatinine and β2- microglobulin in TAF group and ETV group were significantly decreased after 48 weeks of treatment, while eGFR was significantly increased in TAF group (P<0.05). Compared with ETV group, the improvement of renal function was more significant after 48 weeks of treatment (P<0.05). After treatment, the CVR rate and HBeAg negativity rate in TAF group were significantly higher than those in ETV group (P<0.05), but the normalization rate of ALT between the two groups was not statistically significant (P>0.05). Conclusion TAF has obvious advantages in antiviral efficacy of CHB patients, especially in complete virology inhibition, negative HBeAg conversion and improvement of liver function and renal function.

Key words: Chronic hepatitis B, Low-level viremia, Entecavir, Tenofovir alafenamide

吴钰, 李永伟, 周德兵. 恩替卡韦经治慢性乙型肝炎伴低病毒血症患者换用富马酸丙酚替诺福韦治疗的效果[J]. 肝脏, 2025, 30(7): 963-966.

WU Yu, LI Yong-wei, ZHOU De-bing. Therapeutic efficacy of switching to tenofovir alafenamide fumarate in entecavir-treated chronic hepatitis B patients with low-level viremia[J]. Chinese Hepatolgy, 2025, 30(7): 963-966.

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