替比夫定持续治疗HBeAg阳性慢性乙型肝炎患者病毒学应答随访报告

目的 探讨替比夫定持续治疗HBeAg阳性慢性乙型肝炎3年时病毒学指标变化情况。方法 选择91例HBeAg阳性慢性乙型肝炎患者，给予替比夫定600mg口服，1次/d，持续治疗3年，随访观察患者治疗前后病毒学指标的变化及其相关影响因素。结果 91例患者均接受替比夫定持续治疗3年，结果血清HBV DNA检测不出率为86.8%，血清HBeAg转阴率为70.3%，HBeAg血清学转换率为34.1%；经分层分析，46例治疗24周时血清HBV DNA＜500拷贝/毫升的患者治疗3年时血清HBV DNA检测不出率达100.0%，而45例血清HBV DNA＞500拷贝/毫升的患者则为73.3%（P＜0.05），且前者血清HBeAg转阴率和HBeAg血清学转换率亦分别明显高于后者（P＜0.05）；治疗3年时，41例＜30岁、37例女性患者分别较50例＞30岁和54例男性患者获得了更高的HBeAg血清学转换率（P＜0.05），年龄和性别为治疗3年时HBeAg血清学转换率的独立预测因素（P＜0.05）。结论 替比夫定持续治疗HBeAg阳性慢性乙型肝炎3年能够显著抑制HBV复制，治疗24周时血清HBV DNA水平低、年龄轻、女性可能为疗效较好的预测因素。

Observation of three-year followed-up virologic and serological response of serum HBeAg positive patients with chronic hepatitis B receiving telbivudine treatment

Objective To investigate the three-year followed-up virologic and serological response of serum HBeAg positive patients with chronic hepatitis B receiving telbivudine treatment. Methods Ninety-one serum HBeAg positive patients with chronic hepatitis B received monotherapy of telbivudine 600 mg orally once daily for continuous treatment of 3 years. The virologic，serologic and biochemical response were observed，and the related factors affecting virological and serologic response after treatment were analyzed. Results At the end of 3 year treatment，serum HBV DNA loss was 86.8%，serum HBeAg clearance rate was 70.3%，and HBeAg seroconversion rate was 34.1% in this series；By hierarchical analysis，serum HBV DNA loss，serum HBeAg clearance，and HBeAg seroconversion rates at the end of three years in 46 patients with serum HBV DNA<500 copies/ml at 24th week treatment were much higher than those in 45 with serum HBV DNA>500 copies/ml at 24th week （100.0% vs. 73.3%，95.7% vs. 44.4%，and 65.2% vs. 2.2%，respectively，P<0.05）；HBeAg seroconversion rates at the end of three year treatment in 41 patients younger than 30 year old and 37 female patients were much higher than in 50 patients older than 30 year old and 54 male patients（48.8% vs. 22.0%，and 48.6% vs. 24.1%，P<0.05）；The Logistic regression analysis showed that age and gender were the independent predicting factors for 3-year HBeAg seroconversion rate. Conclusion Continuous telbivudine treatment can effectively suppress HBV replication in HBeAg positive patients with chronic hepatitis B. The patients with serum HBV DNA loss at the end of 24th week treatment，younger and female patients might have more choice for virologic and serologic response in HBeAg positive patients with chronic hepatitis B receiving telbivudine therapy.