恩替卡韦与替诺福韦酯治疗高病毒载量慢性乙型肝炎患者的效果分析.

To investigate the efficacy of entecavir (ETV)versus tenofovir disoproxil fumarate (TDF)and the treatment measures for poor response in previously untreated chronic hepatitis B (CHB)patients with high viral load. Methods A total of 165 CHB patients who received antiviral therapy and met the inclusion criteria in Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, from June 2016 to July 2021 were enrolled. The patients enrolled had a baseline HBV DNA level of > 6lg copies/ ml and were previously untreated CHB patients who had used ETV or TDF for 48 weeks, and quantitative real - time PCR was used to measure HBV DNA. Virologic response rate was calculated after 48 weeks of treatment;a logistic regression analysis was used to investigate the influencing factors for the response of HBV DNA < 500 copies/ mL and HBV DNA < 100 copies / mL at 48 weeks;a stratified analysis was performed to compare the virologic response rate of HBV DNA < 500 copies / ml and HBV DNA < 100 copies/ ml after 48 weeks between the patients with different ages, sexes, baseline HBV DNA levels, baseline alanine aminotransferase (ALT)levels, types of first - line medication, and HBeAg statuses. The Mann - Whitney U test was used for comparison of non - normally distributed continuous data between two groups, the chi - square test or the Fisher's exact test was used for comparison of categorical data between two groups, and the binary logis? tic regression model was used for multivariate analysis. Results After 48 weeks of treatment, 85. 5% (141 / 165)of the patients achieved an HBV DNA load of < 500 copies/ mL, and 66. 1% (109 / 165)of the patients achieved an HBV DNA load of < 100 copies / mL, with no significant difference in treatment outcome between the ETV group and the TDF group. The multivariate logistic regression analysis showed that sex(OR = 2. 793, 95% CI:1. 197 - 6. 517), baseline HBV DNA(OR = 0. 369, 95% CI:0? 142 - 0. 959), baseline ALT(OR = 4. 556, 95% CI:1. 770 - 11. 732), and baseline HBeAg(OR = 0. 120, 95% CI:0. 033 - 0. 429)were influencing factors for complete virologic response(all P < 0. 05). For the patients with normal ALT (=40 U/ L)at baseline, 75. 6% (34 / 45)achieved an HBV DNA load of < 500 copies/ mL after 48 weeks of treatment, and 53. 3% (24 / 45)achieved an HBV DNA load of < 100 copies/ mL, with no significant difference in treatment outcome between the ETV group and the TDF group. For the patients with abnormal ALT (> 40 U/ L)at baseline, 89. 2% (107 / 120)achieved an HBV DNA load of < 500 copies/ mL after 48 weeks of treatment, and the proportion of such patients in the TDF group was significantly higher than that in the ETV group (96. 1% vs 84. 1%, 2 = 4. 386, P = 0. 036);70. 8% (85 / 120)achieved an HBV DNA load of < 100 copies/ mL, the proportion of such patients was no significant difference between the TDF group and the ETV group (78. 4% vs 65. 2% ). The response of HBV DNA < 100 copies/ ml of the normal baseline ALT group and the abnormal baseline ALT group, there were no significant differences between the patients aged=30 years and aged > 30 years (77. 8% vs 47. 2%, 85. 2% vs 66. 7%). For the patients who did not achieve complete virologic response (HBV DNA =100 copies/ mL)after 48 weeks of treatment, 87. 9% (29 / 33)achieved complete virologic response after the original treatment regimen was prolonged for 48 weeks, and 100% (9 / 9)of the patients achieved complete virologic response after switching to or adding the first - line nucleos(t)ide analogues (NUCs)without cross - resistance sites with the original regimen for another 48 weeks. Conclusion The patients aged > 30 years should receive antiviral therapy as early as possible, regardless of viral load and ALT level, especially those with a family history of liver cirrhosis or hepatocellular carcinoma;the patients aged =30 years who have a normal ALT level and a high viral load should consider initiating antiviral therapy after providing informed consent. For the patients with poor response after 48 weeks of treatment, first - line NUCs without cross - resistance sites with the original regimen should be switched to or added in time. [ABSTRACT FROM AUTHOR]