替诺福韦酯和恩替卡韦治疗老年慢性乙型肝炎患者的抗病毒疗效及对致炎细胞因子的调节作用

doi:10.13481/j.1671-587x.20190122

摘要/Abstract

摘要： 目的：比较替诺福韦酯（TDF）和恩替卡韦（ETV）治疗老年慢性乙型肝炎（CHB）患者的临床疗效及其对致炎细胞因子的调节作用，为其临床应用提供依据。方法：选取老年CHB患者93例，随机分为TDF组48例和ETV组45例，分别服用TDF （300mg/次，每天1次）和ETV （0.5mg/次，每天1次），连续观察48周。检测治疗前及治疗后4、12、24、36和48周时患者血清中HBV-DNA、丙氨酸氨基转移酶（ALT）、肿瘤坏死因子α（TNF-α）和白细胞介素10（IL-10）水平，检验ALT复常率、HBV-DNA阴转率和HBeAg阴转率。结果：与治疗前比较，治疗后2组患者血清中HBV-DNA和ALT水平均明显降低（P<0.05），治疗4和12周时TDF组患者血清中HBV-DNA和ALT水平明显低于ETV组（P<0.05）。与治疗前比较，治疗后2组患者血清中TNF-α和IL-10水平均明显下降，治疗12周时开始2组患者血清TNF-α和IL-10水平差异均有统计学意义（P<0.05）。治疗后，2组患者ALT复常率逐渐升高，治疗4和12周时TDF组患者ALT复常率明显高于ETV组（P<0.05）。治疗4周时2组患者均出现完全病毒学应答，HBV-DNA阴转率逐渐升高，治疗4、12和24周时，TDF组患者HBV-DNA阴转率明显高于ETV组（P<0.05）。TDF组患者于12周开始出现HBeAg阴转，早于ETV组；ETV组患者于24周出现HBeAg阴转，2组患者HBeAg阴转率比较差异无统计学意义（P>0.05）。结论：TDF和ETV均可用于治疗老年CHB，TDF抗病毒作用起效早，肝功能恢复快，炎症反应轻，是临床治疗的理想抗病毒药物。

关键词: 替诺福韦酯, 恩替卡韦, 慢性乙型肝炎, 细胞因子, 老年人

Abstract: Objective: To compare the clinical efficacies of tenofovir(TDF)and entecavir(ETV)in the treatment of the aged patients with chronic hepatitis B(CHB)and their regulation on the inflammation factors,and to provide basis for their clinical application.Methods: A total of 93 aged patients with CHB were selected and randomly divided into TDF group(n=48)and ETV group(n=45). And the patients were treated with TDF (300 mg/time, 1 time·d^-1)and ETV(0.5 mg/time, 1 time·d^-1);the patients in two groups were observed for continuous 48 weeks. The levels of serum hepatitis B virus-deoxyribonucleic acid(HBV-DNA), glutamic pyruvic transaminase(ALT), and tumor necrosis factor α(TNF-α), interleukin-10(IL-10),the ALT recovery rates,the HBV-DNA negative conversion rates,and the HBeAg negative rates of the patients in two groups were detected before treatment and 4,12,24,36 and 48 weeks after treatment, respectively.Results: Compared with before treatment,the levels of serum HBV-DNA and ALT of the patients in two groups after treatment were decreased(P<0.05); the levels of serum HBV-DNA and ALT of the patients in TDF group were significantly lower than those in ETV at 4 and 12 weeks after treatment(P<0.05). Compared with before treatment,the levels of serum TNF-α and IL-10 of the patients in two groups after treatment were significantly decreased, and there were statistically significant differences between two groups at 12 weeks after treatment (P<0.05). After treatment, the ALT recovery rates of the patients in two groups were increased gradually; the ALT recovery rates in TDF group were significantly higher than those in ETV group (P<0.05) at 4 and 12 weeks after treatment. The patients in two groups showed complete virological responses at 4 weeks after treatment, and the HBV-DNA negative conversion rates were increased gradually. The negative conversion rates of HBV-DNA in TDF group were significantly higher than those in ETV group (P<0.05) at 4, 12 and 24 weeks after treatment. The negative conversion of HBeAg in TDF group appeared at 12 weeks, which was earlier than that in ETV group;the negative conversion of HBeAg in ETV group appeared at 24 weeks; there was no significant difference in HBeAg negative conversion rate between two groups (P>0.05).Conclusion: Both TDF and ETV could be used to treat the aged patients with CHB. TDF has earlier antiviral effect and can bring quick recovery in liver function with lighter inflammatory reaction. TDF is an ideal antiviral drug for clinical treatment.

Key words: tenofovir, entecavir, chronic hepatitis B, cytokine, aged

中图分类号:

R512.6

赵阳, 李烨, 齐玲, 赵臣. 替诺福韦酯和恩替卡韦治疗老年慢性乙型肝炎患者的抗病毒疗效及对致炎细胞因子的调节作用[J]. 吉林大学学报(医学版), 2019, 45(01): 117-122.

ZHAO Yang, LI Ye, QI Ling, ZHAO Chen. Antiviral curative effects of tenofovir and entecavir in treatment of aged patients with chronic hepatitis B and their regulation on inflammation factors[J]. Journal of Jilin University(Medicine Edition), 2019, 45(01): 117-122.

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