阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎的近期疗效观察

目的　观察阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎2年的疗效。方法　2007年1月－2009年1月间178例慢性乙型肝炎患者随机分为试验组91例和对照组87例。试验组给予胸腺五肽1mg，隔日皮下注射，疗程52周；同时阿德福韦酯10mg/d口服104周。对照组给予阿德福韦酯10mg/d，口服104周。治疗26、52、104周及停药52周时，分别检测血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乙型肝炎病毒（HBV）DNA含量及HBV血清标志物。结果　治疗52周后，试验组在ALT复常率、AST复常率、HBVDNA转阴率、HBeAg转阴率与HBeAg/HBeAb血清转换率方面都比对照组高。停药52周时，试验组与对照组的ALT复常率、AST复常率、HBVDNA转阴率、HBeAg转阴率、HBeAg/HBeAb血清转换率分别为74.73%与51.72%、75.82%与54.02%、25.27%与8.05%、26.37%与10.34%、18.68%与8.05%（χ2=10.652、9.313、9.421、7.574、4.313，P＜0.05）。结论　阿德福韦酯联合胸腺五肽治疗HBeAg阳性慢性乙型肝炎比单独使用阿德福韦酯抗病毒治疗效果更好，有助于提高HBeAg/HBeAb血清转换率，减少停药后病毒学突破，并且使用安全。Objective　Toevaluatetheefficacyofadefovirdipivoxil(ADV)combinedwiththymopentinonchronichepatitisBpatientswithpositivehepatitisBeantigen(HBeAg).Methods　BetweenJanuary2007andJanuary2009,178chronichepatitisBpatientswithpositiveHBeAgwererandomlydividedintotwogroupsthetreatmentgroup(91cases)andthecontrolgroup(87cases).Allpatientsintwogroupsreceived10mgofADVonceadayfor104weeks,whilethepatientsinthetreatmentgroupreceived1mgofthymopentinforsubcutaneousinjectioneveryotherdayfor52weeks.Theratesofalanineaminotransferase(ALT)andaspartateaminotransferase(AST)normalization,serumhepatitisBvirus(HBV)DNAclearanceandHBeAglossandanti-HBeAgseroconversionwereevaluatedatpretreatment,and52,104and156weeksaftertreatment,respectively.Results　After52-weektreatment,TheratesofALTandASTnormalization,serumHBVDNAclearanceandHBeAglossandanti-HBeAgseroconversioninthetreatmentgroupwerehigherthanthoseinthecontrolgroup.In52-weekfollow-upafter104weekstreatment,theratesofALTandASTnormalization,serumHBVDNAclearanceandHBeAglossandanti-HBeAgseroconversionoftwogroupswere74.73%versus51.72%,75.82%versus54.02%,25.27%versus8.05%,26.37%versus10.34%,18.68%versus8.05%,respectively(χ2=10.652,9.313,9.421,7.574,4.313;P＜0.05).Conclusions　ItismoreeffectiveforadefovirdipivoxilcombinedwiththymopentinonHBeAg-positivepatientswithchronichepatitisBthanusingadefoviralone.CombinationtreatmentcouldimprovetheratesofHBeAgseroconversionandreducethebreakthroughofHBVafterdrugwithdrawal.Anditissafe.