宋慧萍

[摘要]目的 观察替比夫定治疗育龄期男性慢性乙型肝炎患者的效果及不良反应，为该类患者抗病毒治疗药物选择提供临床循证医学依据。方法 选取2013年1～12月我院收治的68例慢性乙型肝炎患者，按照治疗方法的不同分为治疗组（36例）和对照组（32例）。治疗组在保肝、降酶的基础上服用替比夫定，对照组仅给予保肝降酶治疗，比较两组的效果。结果 治疗组治疗12、24、48周时的HBV-DNA水平低于对照组，差异有统计学意义（P<0.01）。两组治疗4、8周时的ALT复常率比较，差异无统计学意义（P>0.05）。治疗组治疗12、24周时的ALT复常率高于对照组，差异有统计学意义（P<0.05）。两组婴儿出生时、出生后6个月、出生后12个月的HBsAg阳性率比较，差异无统计学意义（P>0.05）。治疗组有2例出现肌酸激酶升高，均为2级以下升高，1例治疗第1周时出现头晕、恶心不适。结论 替比夫定有相对高效的抗病毒作用，不良反应少，对育龄男性具有良好的安全性。

[关键词]替比夫定；育龄期；疗效

[中图分类号] R512.6+2 [文献标识码] A [文章编号] 1674-4721（2017）05（b）-0118-04

Effect observation of Telbivudine in the treatment of child-bearing period male patients with chronic hepatitis B

SONG Hui-ping

Department of Infectious Diseases，the First Hospital of Sanming of Fujian Medical University，Sanming 365000，China

[Abstract]Objective To investigate the effect and adverse reaction of Telbivudine in the treatment of child-bearing period male patients with chronic hepatitis B.Methods 68 cases of chronic hepatitis B from January to December in 2013 in our hospital were selected and divided into the treatment group （36 cases） and the control group （32 cases） according to different treatment methods.The treatment group was given Telbivudine therapy on the basis of liver protection and enzyme reduction，the control group was given only liver protection and enzyme reduction.The effect of the two groups was compared.Results The level of HBV-DNA in the treatment group at 12，24 and 48 weeks was lower than that in the control group，with significant difference （P<0.01）.There was no significant difference in the ALT recover normal rate between the two groups at 4 and 8 weeks （P>0.05）.The recovery normal rate of ALT in the treatment group at 12 and 24 weeks was higher than that in the control group，with significant difference （P<0.05）.There was no significant difference in the HBsAg positive rate of the two groups at birth，6 months after birth and 12 months after birth （P>0.05）.There were 2 cases with elevated creatine kinase in the treatment group，all of which were elevated below grade 2，and there was 1 case of dizziness and nausea at first weeks of treatment.Conclusion Telbivudine has antiviral effect with relatively high efficiency，with less adverse reaction，it is safe for male of childbearing age.

[Key words]Telbivudine；Child-bearing period；Curative effect

慢性乙型肝炎是我國的常见病、多发病，可见于各个年龄阶段。目前，慢性乙型肝炎的治疗把抗病毒放在首位，核苷（酸）类似物因其强效抗病毒作用、副作用少、服用方便而广泛应用于临床[1]。替诺福韦酯（TDF）和恩替卡韦（ETV）为高耐药基因屏障的核苷（酸）类似物[2]。2015年亚太肝病研究协会（APASL）、美国肝病研究协会（AASLD）均推荐TDF或者ETV作为核苷（酸）类似物治疗慢性乙型肝炎的一线治疗药物[3-4]。育龄期男性患者因考虑生育的影响，有其用药的特殊性和选择性，恩替卡韦对男性生育的安全性尚未得到临床广泛认可，而替诺福韦酯价格相对昂贵，故这两种药物均限制了育龄期男性患者应用。……