恩替卡韦、富马酸替诺福韦二吡呋酯及富马酸丙酚替诺福韦治疗慢性乙型肝炎的疗效及安全性分析
The efficacy and safety analysis of entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide fumarate in the treatment of chronic hepatitis B
程家喜 1王万党 2石梅彬 1黄祥亚 1杨洁 1李巧珊 1邹绮明 1李娟1
作者信息
- 1. 528415,中山市小榄人民医院感染科
- 2. 528415,中山市小榄人民医院检验科
- 折叠
摘要
目的 观察恩替卡韦(entecavir,ETV)、富马酸替诺福韦二吡呋酯(tenofovir disoproxil fumarate,TDF)及富马酸丙酚替诺福韦(tenofovir alafenamide fumarate,TAF)抗病毒治疗慢性乙型病毒性肝炎(慢乙肝)的临床疗效及安全性.方法 选择2021年3月—2023年6月我院收治的181例慢乙肝患者,依据抗病毒治疗用药不同分为3组,ETV组(n=66)、TDF组(n=64)及TAF组(n=51).比较3组患者的血脂、肝功能、HBsAg、HBV DNA、血肌酐及估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)等指标在治疗前后及组间的差异.结果 ETV组有效率为86.36％(57/66),TDF组有效率为90.63％(58/64),TAF组有效率为90.20％(46/51),3组比较差异无统计学意义(P>0.05).治疗后,3组的HBsAg水平、HBV DNA载量均低于治疗前(P均<0.05),且3组间HBsAg水平、HBV DNA载量的变化幅度比较,差异具有统计学意义(P<0.05).治疗后,3组的ALT、AST水平均低于治疗前(P均<0.05),且3组间ALT、AST水平的变化幅度比较,差异有统计学意义(P<0.05).治疗后,ETV组的HDL-C、LDL-C均高于治疗前(P均<0.05),TC、TG较治疗前差异均无统计学意义(P均>0.05);TDF组的TC、HDL-C均低于治疗前(P均<0.05),TG、LDL-C较治疗前差异均无统计学意义(P均>0.05);TAF组的TC、TG、HDL-C、LDL-C较治疗前差异均无统计学意义(P均>0.05),但3组间TC、TG、HDL-C、LDL-C的变化幅度比较,差异均有统计学意义(P均<0.05).治疗后,3组的血肌酐、eGFR较治疗前差异均无统计学意义(P均>0.05),但3组间血肌酐、eGFR的变化幅度比较,差异均有统计学意义(P均<0.05).结论 ETV、TDF、TAF治疗慢乙肝的临床疗效相近,服用TAF不会对血脂造成影响,但服用ETV会引起HDL-C、LDL-C水平升高,服用TDF可降低TC、HDL-C水平,并且均有较好的肾脏安全性.
Abstract
Objective To observe the clinical efficacy and safety entecavir ( ETV ), tenofovir disoproxil fumarate ( TDF ), tenofovir alafenamide fumarate ( TAF ) in antiviral treatment of chronic hepatitis B. Methods From March 2021 to June 2023, 181 patients with chronic hepatitis B admitted to our hospital were grouped into 3 groups according to different antiviral drugs. Sixty-six patients in the ETV group only took ETV, 64 patients in the TDF group only took TDF, and 51 patients in the TAF group only took TAF. Blood lipids, liver function, hepatitis B virus surface antigen ( HBsAg ), hepatitis B virus deoxyribonucleic acid ( HBV DNA ), blood creatinine, and estimated glomerular filtration rate ( eGFR ) were compared. Results The effective rate was 86.36％ ( 57/66 ) in the ETV group, 90.63％ ( 58/64 ) in the TDF group, and 90.20％ ( 46/51 ) in the TAF group. There was no significant difference among the 3 groups ( P >0.05 ). After treatment, HBsAg level and HBV DNA load in the 3 groups were lower than those before treatment ( P <0.05 ), and the changes in HBsAg level and HBV DNA load among the 3 groups were statistically significant ( P <0.05 ). After treatment, the levels of ALT and AST in the 3 groups were lower than those before treatment (P <0.05), and the changes of ALT and AST levels among the 3 groups were statistically significant ( P <0.05 ). After treatment, HDL-C and LDL-C in ETV group were higher than those before treatment ( P <0.05 ), and there was no significant difference in TC and TG ( P >0.05 ). TC and HDL-C in TDF group were significantly lower than those before treatment ( P <0.05 ), TG and LDL-C were not significantly different from those before treatment ( P >0.05 ). There were no significant differences in TC, TG, HDL-C and LDL-C in the TAF group compared with those before treatment ( P>0.05 ), but there were significant differences in the changes of TC, TG, HDL-C and LDL-C among the 3 groups (P <0.05 ). After treatment, there were no significant differences in serum creatinine and eGFR among the 3 groups ( P>0.05 ), but there were significant differences in the changes of serum creatinine and eGFR among the three groups ( P <0.05 ). Conclusions The clinical efficacy of ETV, TDF and TAF in the treatment of chronic hepatitis B is similar. Taking TAF will not affect blood lipids, but taking ETV will increase HDL-C and LDL-C, and taking TDF can reduce TC and HDL-C, and all have good renal safety.
关键词
核苷(酸)类似物/抗病毒/慢性乙型肝炎/血脂/恩替卡韦/富马酸替诺福韦二吡呋酯/富马酸丙酚替诺福韦Key words
nucleoside analogues and nucleotide analogues/antivirus/chronic hepatitis B/blood fat/entecavir/tenofovir disoproxil fumarate/tenofovir alafenamide fumarate引用本文复制引用
基金项目
中山市卫生局项目(2022A020317)
出版年
2024
NETL
NSTL
万方数据