Comparison of prolonged use of tenofovir and entecavir in treatment of hepatitis B virus-related cirrhosis
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摘要:
目的对比长期应用替诺福韦和恩替卡韦治疗乙肝肝硬化的临床疗效。 方法回顾性分析2012年7月~2015年8月在我院治疗的未进行肝移植的120例乙肝肝硬化患者，其中62例接受替诺福韦抗病毒治疗，58例接受恩替卡韦治疗。替诺福韦治疗组平均随访时间20个月（7~42），恩替卡韦治疗组平均随访时间21个月（7~44），收集患者的临床和实验室数据，对比两种药物的治疗效果。 结果平均随访1年时，替诺福韦治疗组92%的患者HBV DNA水平低于20 U/mL，57.3%的患者丙氨酸氨基转移酶恢复正常范围；恩替卡韦治疗组90.6%的患者HBV DNA水平低于20 U/mL，56.5%的患者丙氨酸氨基转移酶恢复正常范围，两组间无显著统计学差异（P > 0.05）。末次随访阶段，替诺福韦治疗组31%的患者表现为Child-Turcotte-Pugh评分的改善且65%的患者保持稳定；恩替卡韦治疗组29.2%的患者表现为Child-Turcotte-Pugh评分的改善且63.2%的患者保持稳定，两组间无显著统计学差异（P > 0.05）。3年累计肝失代偿率、肝癌发生率和肝硬化发生率在替诺福韦治疗组分别为3.1%、1.9%和2.1%；恩替卡韦治疗组分别为2.9%、2.2%和2.4%，两组间无显著统计学差异（P > 0.05）。 结论替诺福韦和恩替卡韦在乙肝肝硬化的长期治疗中均能获得良好的临床疗效，提高患者生活质量。 Abstract:ObjectiveTo elevate the long-term efficacy and outcome of tenofovir and entecavir in treatment of hepatitis B virus-related cirrhosis. MethodsWe retrospectively analyzed laboratory and clinical data of 120 HBV-related cirrhotic patients without liver transplantation, who were treated with tenofovir/entecavir therapy from July 2012 to August 2015. 62 and 58 patients were initiated tenofovir and entecavir, respectively. Follow up period was 20 (7-42) months for tenofovir and 21(7-44) months for entecavir. ResultsAt the end of 1 year, levels of HBV DNA < 20 IU/mL were achieved in 92% and 90.6% of patients, and alanine aminotransferase normalized in 57.3% and 56.5% of patients who received tenofovir and entecavir, respectively. At the last visit, Child-Turcotte-Pugh scores improved among 31% of patients who received tenofovir, 29.2% of those who received entecavir, and remained stable in 65% and 63.2% patients, respectively, in both groups. The 3-year cumulative rate of liver decompensation, hepatocellular carcinoma, and cirrhosis-related complications were 3.1%, 1.9%, 2.1% and 2.9%, 2.2%, 2.4% respectively. ConclusionTenofovir and entecavir are effective and potent drugs for prolonged treatment of HBV cirrhosis and improved the overall clinical course. -
Key words:
- hepatitis B virus /
- cirrhosis /
- tenofovir /
- entecavir
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表 1 治疗前两组患者的基本参数(n=120)
组别 治疗前基本参数 性别(男/女) 年龄(岁) 失代偿率(%) 腹水(%) 肝性脑病(%) 曲张静脉出血(%) HbeAg阳性率(%) 替诺福韦组 40/22 48.4 (27~71) 60 10.2 16 55 80 恩替卡韦组 34/24 49.6 (26~68) 63.3 10.6 14 51 77 P > 0.05 
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表 2 随访患者生化和血清学指标变化
组别 随访周期(月) 死亡例数(n) HBV DNA (1年) < 20 U/mL HBeAg转阴 末次随访CTP 末次随访MELD 替诺福韦组 20 (7~42) 6 56 32/80 6 (5~10) 10.3 (4.7~13.6) 恩替卡韦组 21 (7~44) 6 52 29/77 6 (5~10) 10.2 (5.2~14.2) P > 0.05
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表 3 随访阶段肝硬化及抗病毒相关并发症
组别 相关并发症发生率（%） 死亡 失代偿 肝癌 肝硬化相关事件 替诺福韦组 9.6 3.1 1.9 2.1 恩替卡韦组 10 2.9 2.2 2.4 P > 0.05
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