方阳阳

【摘要】 目的：分析阿德福韦酯与恩替卡韦分别联合长效干扰素治疗e抗原阳性慢性乙肝的效果。方法：选取本院2014年8月-2018年3月收治的140例e抗原阳性慢性乙肝患者进行研究，按随机数字表法将其分为观察组与对照组，各70例。所有患者均给予聚乙二醇干扰素a-2a治疗，在此基础上，观察组联合恩替卡韦治疗，对照组联合阿德福韦酯治疗。治疗48周后比较两组患者的治疗效果、肝功能改善情况及并发症发生情况。结果：两组患者ALT复常率、HBeAg转换率及HBsAg转阴率比较，差异均无统计学意义（P>0.05）。观察组HBeAg转阴率及HBV DNA转阴率均高于对照组，差异均有统计学意义（P<0.05）。治疗后，两组患者ALT、AST、ALB和TBIL均较治疗前明显改善，差异均有统计学意义（P<0.05）。治疗前后两组肝功能指标比较，差异均无统计学意义（P>0.05）。两组患者不良反应发生率比较，差异均无统计学意义（P>0.05）。结论：联合聚乙二醇干扰素a-2a治療e抗原阳性慢性乙肝时，恩替卡韦疗效优于阿德福韦酯，但两者对肝功能的改善作用和安全性相近。

【关键词】 乙型肝炎; HBeAg阳性; 恩替卡韦; 聚乙二醇干扰素a-2a; 阿德福韦酯

【Abstract】 Objective：To investigate the treatment effects of Adefovir and Entecavir combined with Peginterferon a-2a in the treatment of HBeAg positive chronic hepatitis B.Method：140 cases of HBeAg positive chronic hepatitis B were selected in our hospital from August 2014 to March 2018，and they were divided into observation group and control group according to random number table，70 cases in each group.All patients were treated with Peginterferon a-2a，on this basis，the observation group was treated with Entecavir and the control group was treated with Adefovir，after 48 weeks of treatment，the therapeutic effect，liver function and the occurrence of adverse reactions of the two groups were compared.Result：After treatment，there were no significant differences in ALT normalization rate，HBeAg conversion rate and HBsAg negative conversion rate between the two groups（P>0.05）.The negative rates of HBeAg and HBV DNA in the observation group were higher than those in the control group，the differences were statistically significant（P<0.05）.After treatment，ALT，AST，ALB and TBIL in the two groups were significantly improved compared with those before treatment，the differences were statistically significant（P<0.05）.There were no significant differences in liver function between the two groups before and after treatment（P>0.05）.There were no significant differences in the incidence of adverse reactions between the two groups（P>0.05）.Conclusion：Entecavir is superior to Adefovir in the treatment of HBeAg positive chronic hepatitis B，but both have similar effect and safety in improving liver function.

【Key words】 Hepatitis B; HBeAg positive; Entecavir; Peginterferon a-2a; AdefovirFirst-authors address：Jiamusi Infectious Diseases Hospital，Jiamusi 154007，China

doi：10.3969/j.issn.1674-4985.2019.17.016

慢性乙肝通常指病程6个月以上的乙肝，慢性乙肝严重时可进展为重型肝炎，甚至发生肝硬化或肝癌[1]。有研究发现，超过40%～60%的慢性乙肝患者合并e抗原阳性[2]。而e抗原阳性患者体内病毒复制极为活跃，是肝硬化甚至肝癌发生的病理基础[3]。因此，抗病毒治疗是控制e抗原阳性慢性乙肝患者病情进展的关键措施[4]。核苷（酸）类似物与长效干扰素是抗病毒治疗的主要药物。两类药物作用靶点与机制不同，联合用药能够发挥协同作用[5]。还有研究证实，核苷（酸）类似物与长效干扰素联合用药能够有效降低耐药突变风险[6]。恩替卡韦……