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[目的]探讨不同HBeAg水平慢性乙型肝炎患者中恩替卡韦临床疗效。[方法]根据治疗前HBeAg血清水平,将90例HBeAg阳性慢性乙型肝炎患者分为3组:A组,HBeAg为大于76.5PEI U/ml,B组38PEI U/ml至76.5PEI U/ml,C组小于38PEI U/ml。前瞻性分析恩替卡韦治疗前HBeAg水平、治疗12周后HBeAg变化与96周临床疗效的关系。应用χ2检验进行数据分析。[结果]3组患者基线ALT水平、年龄及HBV DNA的差异均无统计学意义。90例患者96周时ALT恢复正常90例(100%),病毒学应答率89例(96.7%)。出现HBeAg转阴35例(38.9%),HBeAg转换28例(31.1%)。3组间HBeAg转阴率、HBeAg转换率的差异有统计学意义,3组间ALT复常率、HBV DNA转阴率的差异无统计学意义。C组患者治疗96周时HBeAg转阴率为60%,HBeAg血清学转换率为50%,高于B组的33.3%、30%,A组的23.3%、13.3%。治疗24周时HBeAg水平下降大于50%的35例患者,96周时HBeAg血清学转换率高达21例(60%),而其他55例患者中仅有7例(12.7%)出现HBeAg血清学转换率。[结论]不同HBeAg水平慢性乙型肝炎患者,经恩替卡韦治疗96周后,HBeAg转阴率及HBeAg血清学转换率存在明显差异。基线HBeAg血清学水平及治疗24周后HBeAg下降幅度可作为HBeAg血清学转换及远期疗效的预测因子。
[Objective] To investigate the clinical efficacy of entecavir in patients with chronic hepatitis B with different levels of HBeAg. [Methods] Ninety patients with HBeAg-positive chronic hepatitis B were divided into three groups according to the serum HBeAg level before treatment: group A, HBeAg was greater than 76.5PEI U / ml, group B 38PEI U / ml to 76.5PEI U / ml, Group C less than 38PEI U / ml. The prospective analysis of HBeAg level before entecavir treatment, HBeAg change after 12 weeks of treatment and 96 weeks of clinical efficacy. Χ2 test data analysis. [Results] There was no significant difference in baseline ALT level, age and HBV DNA between the three groups. 90 patients returned to normal ALT at week 96, 90 (100%), and virological response rate was 89 (96.7%). 35 cases (38.9%) had HBeAg negative conversion and 28 cases (31.1%) HBeAg conversion. The difference of HBeAg negative rate and HBeAg conversion rate among the three groups was statistically significant. There was no significant difference between the two groups in ALT normalization rate and HBV DNA negative rate. In group C, the HBeAg negative rate was 60% and the HBeAg seroconversion rate was 50% at 96 weeks. It was higher than 33.3% and 30% in group B and 23.3% and 13.3% in group A, respectively. In the 35 patients who had HBeAg levels decreased by more than 50% at 24 weeks of treatment, HBeAg seroconversion rates were as high as 96 (96%) at week 96 compared to 7 (12.7%) of 55 other patients with HBeAg seroconversion rate. [Conclusion] The HBeAg negative rate and HBeAg seroconversion rate in patients with different HBeAg levels of chronic hepatitis B after entecavir treatment for 96 weeks are significantly different. Baseline HBeAg serology and the reduction in HBeAg after 24 weeks of treatment are predictive of HBeAg seroconversion and long-term outcomes.