核苷（酸）類似物治療HBeAg陰性慢性乙型肝炎停用后復(fù)發(fā)臨床觀察

馬燕　賀征英　王育光

【摘要】 目的：觀察HBeAg陰性慢性乙型肝炎患者給予三種核苷（酸）類似物初始抗病毒治療，達(dá)到2005年版慢性乙型肝炎防治指南停藥標(biāo)準(zhǔn)，停藥1年內(nèi)復(fù)發(fā)情況，分析抗病毒藥物種類、抗病毒療程與復(fù)發(fā)是否存在相關(guān)性。方法：選取2005年1月-2013年1月本院確診的HBeAg陰性慢性乙型肝炎患者146例為治療組，其中拉米夫定46例，阿德福韋53例，恩替卡韋47例，復(fù)發(fā)患者為復(fù)發(fā)組108例。治療組觀察病例數(shù)、年齡、性別、HBVDNA定量、ALT值、國(guó)際標(biāo)準(zhǔn)化比值（INS）及中位抗病毒療程，復(fù)發(fā)組觀察病例數(shù)、年齡、性別、中位抗病毒療程及復(fù)發(fā)率。比較三種抗病毒藥物停藥1年的復(fù)發(fā)率；復(fù)發(fā)組觀察4個(gè)時(shí)間段（3個(gè)月內(nèi)，3～6個(gè)月，6～9個(gè)月，9～12個(gè)月）的復(fù)發(fā)例數(shù)；治療組以抗病毒療程（≤3年，>3年）分兩組，比較兩組復(fù)發(fā)率。結(jié)果：達(dá)到停藥標(biāo)準(zhǔn)1年的患者，拉米夫定復(fù)發(fā)率69%，阿德福韋為77%，恩替卡韋為74%。三種核苷（酸）類似物總體復(fù)發(fā)率74%，比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。復(fù)發(fā)時(shí)間段集中于3～6個(gè)月，抗病毒療程≤3年74例，復(fù)發(fā)55例（74.3%）；>3年72例，復(fù)發(fā)53例（73.6%），兩組復(fù)發(fā)率比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：三種核苷（酸）類似物初治HBeAg陰性慢性乙型肝炎達(dá)到停藥標(biāo)準(zhǔn)停藥1年內(nèi)復(fù)發(fā)率高，但無顯著差異，抗病毒療程與復(fù)發(fā)未發(fā)現(xiàn)具有相關(guān)性。

【關(guān)鍵詞】 核苷（酸）類似物； HBeAg陰性慢性乙型肝炎； 復(fù)發(fā)

【Abstract】 Objective：To observe the patients with HBeAg negative chronic hepatitis B initially treated by 3 kinds of nucleoside （acid） analogues reached the withdrawal standard according to the 2005 edition of chronic hepatitis B prevention and treatment guidelines and the relapse within a year after withdrawal，also to analyse whether there is a correlation among the variety of antiviral drugs， antiviral treatment and viral relapse.Method：146 patients with HBeAg negative chronic hepatitis B diagnosed in our hospital from January 2005 to January 2013 were selected as treatment group，including 46 cases treated with Lamivudine，53 cases with Adefovi，47 cases with Entecavir. 108 recurrent patients were selected as relapse group.The number，age，gender，HBVDNA quantification，ALT value，international normalized ratio and median antiviral treatment period of patients were observed among the treatment groups，and the number，age，gender，relapse rate，median antiviral treatment period and relapse rate of patients were observed in the relapse group.Comparedthe relapse rate of three kinds of antiviral drugs for 1 years；the recurrent group to observe the 4 time periods（under 3 months，3-6 months，6-9 months，9-12 months）were observed in the relapse group，the treatment group were treated with antiviral treatment（≤3 years，>3 years） were divided into two groups，two groups were compared the recurrence rate.Result：Patients who discontinued the standard with 1 year，the recurrence rate was 69% in the Lamivudine group，77% in the Adefovi group，74% in the Entecavir group.The overall relapse rate of three kinds of nucleoside（acid） analogues was 74%，the differences were no statistically significant（P>0.05）.Relapse mainly occured in 3-6 months，the antiviral treatment course under 3 years recured of 74 cases，relepse of 55 cases（74.3%）；the antiviral treatment course over 3 years recured of 72 cases，relepse of 53 cases（73.6%），the differences were no statistically significant（P>0.05）.Conclusion：Patients with HBeAg negative chronic hepatitis B initially treated by 3 kinds of nucleoside（acid） analogues reaching withdrawal standard has high relapse rate in a year after withdrawal，but there is no significant difference.There is no correlation between the antiviral treatment course and relapse.endprint

【Key words】 Nucleoside（acid） analogues； HBeAg negative chronic hepatitis B； Relapse

First-authors address：The Sixth Peoples Hospital of Huizhou，Huizhou 516211，China

doi：10.3969/j.issn.1674-4985.2017.25.009

核苷（酸）類似物是慢性乙肝的主要抗病毒藥物，其中拉米夫定、阿德福韋及恩替卡韋三種核苷（酸）類似物應(yīng)用較廣。通過長(zhǎng)期抗病毒治療，以達(dá)到長(zhǎng)期抑制病毒，保護(hù)肝臟健康為目的已成共識(shí)，但停藥后復(fù)發(fā)是常見問題，可能導(dǎo)致病情惡化的后果，尤其在HBeAg陰性慢性乙型肝炎中更為突出。回顧性分析本院……