刘小琴

[摘要] 目的 分析慢性乙型肝炎患者不規范停用恩替卡韦复发后再次恩替卡韦治疗的病毒学应答效果、疾病进展情况及安全性。方法 回顾性分析该院自2015年1月—2016年12月收治的120例慢性乙型肝炎患者的临床资料，其中39例不规范停用恩替卡韦复发的慢性乙型肝炎患者，占32.50%（39/120），作为复治组；81例慢性乙型肝炎初治患者，占67.50%（81/120），作为初治组；两组患者均采取恩替卡韦治疗，持续治疗48周，于第4、12、24、36、48周，对比两组HBV-DNA阴转率和生化学复常率，以HBeAg转换率、HBsAg滴度下降50%比例、不良反应和耐药性作为观察指标。结果 复治组治疗第4、12周的HBV-DNA阴转率均大于初治组，差异有统计学意义（P<0.05）；两组治疗第24、36、48周的HBV-DNA阴转率差异无统计学意义（P>0.05）；复治组的HBV-DNA阴转速度明显快于初治组；复治组治疗第4、12周的生化学复常率小于初治组，差异有统计学意义（P<0.05）；两组治疗第24、36、48周的生化学复常率差异无统计学意义（P>0.05）；复治组的生化学复常速度明显慢于初治组；复治组HBeAg转换率、HBsAg滴度下降50%比例均大于初治组，差异有统计学意义（P<0.05）；两组患者对恩替卡韦治疗的耐受性较好，未见严重不良反应和耐药病例。结论 慢性乙型肝炎患者不规范停用恩替卡韦复发后再次恩替卡韦治疗仍具有较好的抗病毒效果，安全性尚可，病毒学应答较快，但肝功能恢复较为缓慢，应进一步规范恩替卡韦治疗。

[关键词] 慢性乙型肝炎；恩替卡韦；复发

[中图分类号] R512 [文献标识码] A [文章编号] 1674-0742（2018）01（a）-0023-04

Effect of Entecavir Treatment again after Discontinuation of Entecavir Relapse by Chronic Hepatitis B patients Unregulate Use

LIU Xiao-qin

Department of Infectious Disease， Dianjiang Peoples Hospital， Chongqing， 408300 China

[Abstract] Objective This paper tries to analyze the virologic response， disease progression and safety of entecavir treatment in patients with chronic hepatitis B who did not regulate the recurrence of entecavir. Methods The clinical data of 120 patients with chronic hepatitis B who were admitted to this hospital from January 2015 to December 2016 were retrospectively analyzed. Among them， 39 patients with chronic hepatitis B who did not standardize the relapse of entecavir accounted for 32.50%（39/120） as retargeting group； 81 patients with initial treatment of chronic hepatitis B accounted for 67.50% （81/120）， as the initial treatment group； both groups were treated with entecavir for 48 weeks， in the first 4， 12， 24， 36 and 48 weeks respectively. The HBV-DNA negative rate and biochemical abnormality rate were compared between the two groups. HBeAg conversion rate， 50% reduction of HBsAg titer， adverse reaction and drug resistance were compared. Results The rate of HBV-DNA conversion was significantly higher in the treatment group than that in the untreated group at the 4 th and 12 weeks （P<0.05）. The difference of HBV-DNA negative conversion between the two groups at 24， 36 and 48 th weeks（P>0.05）. The rate of HBV-DNA rotation in the treatment group was significantly faster than that in the newly diagnosed group. The biochemical normalization rate of the treatment group was significantly lower than that of the newly diagnosed group at the 4 and 12 weeks（P<0.05）. There was no significant difference in biochemical abnormalities between the two groups at the 24， 36 and 48 weeks （P>0.05）. The rate of biochemical dysmenorrhea in the treatment group was significantly slower than that in the untreated group. HBeAg conversion rate （P<0.05）.The two groups of patients had better tolerance to entecavir treatment， and no serious adverse reactions and drug resistance cases were found in the two groups. Conclusion Recurrence of entecavir in patients with chronic hepatitis B does not have a good antiviral effect after the recurrence of entecavir. The safety is acceptable， the virological response is faster， but the recovery of liver function is slower， and the treatment of entecavir should be further regulated.

[Key words] Chronic hepatitis B； Entecavir； Relapse

慢性乙型肝炎是一种由乙肝病毒感染引起的传染性疾病，抗病毒治疗已成为控制慢性乙型肝炎病情、改善预后的最关键疗法之一[1]。恩替卡韦作为核苷（酸）类似物，临床普遍采取恩替卡韦治疗慢性乙型肝炎，可抑制乙肝病毒DNA复制，达到控制病情的目的，但难以彻底消除乙肝病毒，导致慢性乙型肝炎患者需持续采取恩替卡韦治疗。由于慢性乙型肝炎的早期症状缺乏特异性，对患者的影响不明显，且部分慢性乙型肝炎患者在长期采取恩替卡韦治疗过程中，因高额医疗费用、健康意识薄弱、治疗依从性较差等因素而不规范停用恩替卡韦，导致慢性乙型肝炎患者因缺乏恩替卡韦治疗而引起病情复发[2]。……