张晓强 余建平 盛吉芳

[摘要] 目的 探討富马酸丙酚替诺福韦（TAF）与阿德福韦酯（ADV）治疗慢性乙型肝炎（CHB）患者的临床效果。 方法 分层抽样法选取杭州市余杭区第一人民医院感染科2019年3—10月的CHB患者，总共128例。治疗前，采用摸球法随机分为两组，每组各64例。研究组给予TAF治疗（TAF组），对照组给予ADV治疗（ADV组）。治疗结束后，比较两组HBV载量、Child-Pugh评分、肝功能指标、肝纤维化、临床疗效指标。 结果 治疗后，TAF组HBV载量指标为（1.48±0.49）copies/mL，明显低于ADV组的（2.69±0.68）copies/mL，差异有统计学意义（P<0.05）;TAF组Child-Pugh分级评分为（5.25±0.69）分，明显低于ADV组的（6.31±1.25）分，差异有统计学意义（P<0.05）;TAF组的血清丙氨酸氨基转移酶（ALT）、谷草转氨酶（AST）、总胆红素（TBiL）、碱性磷酸酶（ALP）明显低于ADV组，差异有统计学意义（P<0.05）;在评价肝纤维化指标中，TAF组层粘连蛋白（LN）、透明质酸酶（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）较ADV组明显降低，差异有统计学意义（P<0.05）;TAF组总有效率为95.31%，明显高于ADV组的79.69%，差异有统计学意义（P<0.05）。 结论 对于慢性乙型肝炎患者，TAF较ADV治疗可明显改善HBV载量、Child-Pugh评分、肝功能，减轻肝纤维化，增加疗效。

[关键词] 慢性乙型肝炎;富马酸丙酚替诺福韦;阿德福韦酯;HBV载量;Child-Pugh评分;肝功能;肝纤维化

[中图分类号] R512.62          [文献标识码] A          [文章编号] 1673-9701（2021）32-0030-04

[Abstract] Objective To investigate the clinical effects of tenofovir alafenamide fumarate （TAF） and adefovir dipivoxil （ADV） on patients with chronic hepatitis B （CHB）. Methods A total of 128 patients with CHB in the Department of Infectious Diseases of First People's Hospital of Yuhang District in Hangzhou from March to October 2019 were selected using a stratified sampling method. Before treatment， they were randomly divided into two groups， with 64 cases in each group. The study group was given TAF treatment （TAF group）， and the control group was given ADV treatment （ADV group）. After the treatment， the HBV load， Child-Pugh score， liver function indexes， liver fibrosis， and clinical efficacy indexes were compared between the two groups. Results After treatment， the HBV load index of the TAF group was（1.48±0.49） copies/mL，which was significantly lower than that of （2.69±0.68） copies/mL in the ADV group， and the difference between the two groups was statistically significant（P<0.05）. The Child-Pugh grading score of the TAF group was（5.25±0.69），which was significantly lower than that of （6.31±1.25） in the ADV group， and the difference between the two groups was statistically significant （P<0.05）. The serum alanine aminoeransferase （ALT）， aspartate aminotransferase （AST）， total bilirrbin （TBIL）， and alkaline phosphatase（ALP） of the TAF group were significantly lower than those in the ADV group， and the difference between the two groups was statistically significant（P<0.05）. In the evaluation of liver fibrosis indicators， the laminin （LN）， hyaluronidase （HA）， Procollagen type Ⅲ （PCⅢ） and type Ⅳ collagen （Ⅳ-C） in the TAF group were significantly lower than those in the ADV group， and the differences between the two groups were statistically significant（P<0.05）. The total effective rate in the TAF group was 95.31%， which was higher than that of 79.69% in the ADV group. The difference between the two groups was statistically significant（P<0.05）. Conclusion For patients with chronic hepatitis B， TAF can significantly improve HBV load， Child-Pugh score， liver function， reduce liver fibrosis， and increase efficacy compared with ADV treatment.

[Key words] Chronic hepatitis B; Tenofovir alafenamide fumarate; Adefovir dipivoxil; HBV load; Child-Pugh score; Liver function; Liver fibrosis

慢性乙型肝炎（Chronic hepatitis B，CHB）是一种常见慢性肝脏炎症性疾病，主要由乙型肝炎病毒（Hepatitis B virus，HBV）感染所致[1-2]。慢性乙型肝炎若不及时干预易导致肝纤维化，引发肝硬化，甚至发展为肝细胞癌[3-4]。目前认为，CHB发病主要原因为HBV大量复制，治疗上需根除病毒或长期、稳定地抑制病毒复制。既往临床多采用干扰素[5]，近年来，常用阿德福韦酯（Defovir dipivoxil，ADV）、富马酸丙酚替诺福韦（Tenofovir alafenamide Fumarate，TAF）等核苷酸类似物。……