张敏

【摘要】 目的：探讨替诺福韦酯单药治疗慢性乙型肝炎的临床效果。方法：密集抽样法选取2015年3月-2018年3月笔者所在医院收治的64例慢性乙型肝炎患者。按照随机数字表法将其分为两组，各32例。对照组给予恩替卡韦单药治疗，研究组给予替诺福韦酯单药治疗。比较两组临床疗效。结果：治疗6、12个月时，研究组HBV DNA转阴率分别为68.75%、93.75%，均高于对照组的40.63%、56.25%，差异有统计学意义（字2=5.107、12.000，P=0.023、0.000）。治疗6、12个月时，研究组ALT复常率分别为71.88%、96.88%，均高于對照组的43.75%、62.50%，差异有统计学意义（字2=5.189、11.680，P=0.022、0.000）。研究组不良反应发生率为6.25%，低于对照组的28.13%，差异有统计学意义（字2=5.379，P=0.020）。结论：慢性乙型肝炎采用替诺福韦酯单药治疗效果显著，可提升HBV DNA转阴率、ALT复常率，改善肾功能，且不良反应少，值得临床推广。

【关键词】 慢性乙型肝炎 替诺福韦酯 恩替卡韦

doi：10.14033/j.cnki.cfmr.2019.29.005 文献标识码 A 文章编号 1674-6805（2019）29-00-03

[Abstract] Objective： To investigate the clinical efficacy of Tenofovir Disoproxil alone in the treatment of chronic hepatitis B. Method： A total of 64 patients with chronic hepatitis B admitted in our hospital from March 2015 to March 2018 were selected by intensive sampling method. According to the random number table method， they were divided into two groups， with 32 cases in each group. The control group was treated with Entecavir monotherapy， while the study group was treated with Tenofovir Disoproxil monotherapy. The efficacy of the two groups was compared. Result： At 6 and 12 months of treatment， the HBV DNA negative conversion rates in the study group were 68.75% and 93.75%， respectively ， which were higher than 40.63% and 56.25% in the control group， the differences were statistically significant （字2=5.107， 12.000， P=0.023， 0.000）. At 6 and 12 months of treatment， the ALT recurrence rates in the study group were 71.88% and 96.88%， respectively， which were higher than 43.75% and 62.50% in the control group， the differences were statistically significant （字2=5.189， 11.680， P=0.022， 0.000）. The incidence of adverse reactions in the study group was 6.25%， which was lower than 28.13% in the control group， the difference was statistically significant （字2=5.379， P=0.020）. Conclusion： Tenofovir Disoproxil monotherapy for chronic hepatitis B has a significant therapeutic effect， which can improve the rate of HBV DNA negative conversion and ALT recurrence， improve renal function， and have fewer adverse reactions， which is worthy of clinical promotion.

[Key words] Chronic hepatitis B Tenofovir Disoproxil Entecavir

First-authors address： General Hospital of Xuzhou Mining Group， Xuzhou 221000， China

近年来，慢性乙型肝炎逐渐发展成为严重威胁人们身心健康、生活质量的重要疾病之一，全球范围内发病率、病死率均较高[1]。该病主要由乙型肝炎病毒（HBV）感染所致，若不及时治疗，可导致出现一系列重症疾病，包括肝功能衰竭、肝硬化等[2]。该病还具有一定传染性，且传染途径较多，如血液、体液等。故需强化早期防治力度，选择恰当治疗方案，切实改善患者预后。目前，临床多采用抗病毒药物治疗，包括恩替卡韦、替诺福韦酯、阿德福韦酯等。其中替诺福韦酯属于单磷酸腺苷类似物，被各国指南推荐为慢性乙型肝炎抗病毒首选一线药物之一，但临床就其治疗中单用时效果及安全性仍存在较大争议[3]。……