目的 對比觀察替比夫定（LdT）聯(lián)合阿德福韋酯（ADV）治療青年高病毒載量乙型肝炎e抗原（HBeAg）陽性慢性乙型病毒性肝炎（CHB）的療效。方法 106例HBeAg陽性、HBV DNA≥10⁷ 拷貝/mL的青年CHB初治患者分為替比夫定（LdT）聯(lián)合阿德福韋酯（ADV）聯(lián)合治療組（54例）和恩替卡韋（ETV）對照組（52例）。聯(lián)合治療組口服LdT 600 mg/d+ADV 10 mg/d，1次/d；對照組口服ETV 0.5 mg/d，1次/d。總療程48周，觀察兩組患者治療12、24、36、48周時乙型病毒性（HBV）DNA陰轉(zhuǎn)率、HBeAg血清學(xué)轉(zhuǎn)換率及丙氨酸氨基轉(zhuǎn)移酶（ALT）的復(fù)常率。結(jié)果 治療后，兩組患者均取得較好的療效，獲得較高的HBV DNA轉(zhuǎn)陰率和ALT復(fù)常率。在治療第12、24、36、48周時兩組的HBV DNA陰轉(zhuǎn)率及ALT復(fù)常率比較，差異均無統(tǒng)計(jì)學(xué)意義；但聯(lián)合治療組HBeAg血清學(xué)轉(zhuǎn)換率24周后明顯高于ETV對照組（33.3% vs 13.5%，χ²=5.804、P=0.016），差異有統(tǒng)計(jì)學(xué)意義，且36周和48周統(tǒng)計(jì)學(xué)差異更加顯著（42.6% vs 15.4%，χ²=9.477、P=0.002；48.1% vs 19.2%，χ²=9.877、P=0.002）。結(jié)論 替比夫定聯(lián)合阿德福韋酯治療青年高病毒載量的初治HBeAg陽性CHB患者，不僅獲得較高的病毒學(xué)應(yīng)答率和肝功能復(fù)常率，與恩替卡韋相比還能獲得更高的HBeAg血清轉(zhuǎn)換率。

Objective To compare the clinical efficacy of telbivudine combined with adefovir and entecavir alone in young adult patients with Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B and high levels of hepatitis B virus (HBV) DNA. Methods Totally 106 young adult patients with HBeAg positive chronic hepatitis B and HBV DNA ≥ 10⁷copies/mL) were divided into two groups, and 54 patients received combination therapy with telbivudine (600 mg/d) and adefovir dipivoxil (10 mg/d), while 52 patients received entecavir (0.5 mg/d) monotherapy. All the patients were treated for at least 48 weeks. The HBV DNA negative-conversion rate, alanine amino transferase (ALT) normalization rate, and HBeAg seroconversion rate were observed at 12, 24, 36, and 48 weeks. Results After the treatment, the levels of ALT and HBV DNA were significantly decreased in both groups. There were no statistical significances in the rates of HBV-DNA negative conversion and ALT normalization between the two groups at week 12, 24, 36, and 48 (P>0.05 for all). The HBeAg seroconversion rate in the combination group was significantly higher than that in entecavir group at week 24(33.3% vs 13.5%, χ²=5.804, P=0.016), 36 (42.6% vs 15.4%, χ²=9.477, P=0.002) and 48 (48.1% vs 19.2%, χ²=9.877, P=0.002), respectively. Conclusion In young adult patients with HBeAg positive chronic hepatitis B and high levels of HBV DNA, the treatment of telbivudine combined with adefovir achieved not only high HBV-DNA negative-conversion rate and ALT normalization rate, but also higher HBeAg seroconversion rate than entecavir did.

福建省重點(diǎn)課題（2016Y0068）