乙型肝炎病毒DNA高敏检测对替诺福韦或恩替卡韦治疗HBeAg阴性患者临床效果的指导意义

摘要/Abstract

摘要： 目的分析乙型肝炎病毒HBV DNA高敏检测替诺福韦或恩替卡韦治疗乙型肝炎E抗原(HBeAg)阴性患者临床效果的指导意义。方法将我院2015年3月至2017年3月收治的72例HBeAg阴性慢性乙肝患者随机分为A、B两组,各36例,分别给予替诺福韦酯、恩替卡韦治疗。使用高敏定量检测法,分析两组患者治疗前、治疗12周后、治疗24周后、治疗48周后HBV DNA载量变化,并对患者治疗前、治疗48周后HBV突变位点变化进行检测,探讨临床治疗方案选择思路及治疗效果评估对策。结果两组患者治疗12周后HBV DNA载量均较治疗前下降,A组治疗24周后、治疗48周后HBV DNA载量低于B组,差异有统计学意义(P<0.05)。患者治疗后C1653T、C1673T、A1762T、G1764A、G1896、G1858、G1899A耐药突变位点检出率均较治疗前下降,差异有统计学意义(P<0.05),治疗后新检出G1915A/C、L180M、M204V、V207I/L、T184A及V173L突变位点。两组患者治疗48周后ALT复常率、HBV DNA转阴率比较,差异无统计学意义(P>0.05),两组患者治疗期间均未见病毒学突破。两组患者治疗期间均未见肾功能损害、肌病、范可尼综合征等严重不良反应发生。结论替诺福韦酯与恩替卡韦治疗HBeAg阴性乙肝的疗效与安全性相当,但患者治疗后HBV耐药突变位点有所变化,此时应用替诺福韦酯并定期监测患者HBV DNA载量变化,对于下调HBV DNA载量与指导疗效判断有着重要意义。

关键词: 乙型肝炎病毒, 替诺福韦, 恩替卡韦, 乙型肝炎E抗原, 治疗效果

季雪良, 张伟, 龚力, 李国云, 孟丽萍. 乙型肝炎病毒DNA高敏检测对替诺福韦或恩替卡韦治疗HBeAg阴性患者临床效果的指导意义[J]. 肝脏, 2018, 23(12): 1125-1127.

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