Analysis of influencing factors on the efficacy of tenofovir alafenamide fumarate in the treatment of chronic hepatitis B
-
摘要: 目的 初步探讨在慢性乙型病毒性肝炎(CHB)患者口服富马酸丙酚替诺福韦(TAF)病毒治疗过程中(第24周、48周)，影响TAF抗病毒治疗效果的因素。方法 选择2020年4月-2022年1月在门诊或住院的CHB患者为研究对象，回顾性分析其临床资料，根据纳入、排除标准筛选出57例有完整临床资料的CHB患者，分为完全应答组和未完全应答组，运用修正Poissoin回归进行统计分析处理。结果 在抗病毒第24周时，单因素回归中，基线HBV DNA、基线HBsAg、患者之前是否采用过其他抗病毒药物对抗病毒作用差异有统计学意义，多因素回归分析中提示基线HBV DNA差异有统计学意义；在抗病毒治疗第48周时，单因素回归分析提示基线HBV DNA、基线HBsAg差异有统计学意义，多因素回归提示基线HBV DNA差异有统计学意义。结论 CHB患者在口服TAF抗病毒过程中，在第24周、48周时，CHB患者的基线HBV DNA水平可以预测抗病毒的治疗效果。Abstract: Objective To initially investigate the factors influencing the efficacy of tenofovir alafenamide fumarate(TAF) antiviral therapy during the course(24 weeks and 48 weeks) of tenofovir alafenamide fumarate(TAF) viral therapy in patients with chronic viral hepatitis B(CHB patients).Methods Patients with CHB who were outpatients or inpatients in the Hospital between April 2020 and January 2022 were selected as the study subjects, and their clinical data were retrospectively analyzed. According to the inclusion and discharge criteria, a total of 57 CHB patients with complete clinical data were screened into fully responsive and incompletely responsive groups, which were processed for statistical analysis using modified Poissoin regression.Results It shows that there are statistical differences in baseline HBV DNA, baseline HBsAg and whether the patient has used other antiviral drugs before in the univariate regression at the 24th week of antiviral treatment. The multivariate regression analysis shows that there are statistical differences in baseline HBV DNA. At the 48th week of antiviral treatment, the univariate regression analysis shows that there are statistical differences in baseline HBV DNA and baseline HBsAg, Multivariate regression showed that there was a significant difference in baseline HBV DNA.Conclusion It shows that the baseline HBV DNA level of CHB patients can predict the antiviral treatment effect at 24 and 48 weeks.
-
-
[1] Razavi-Sheare D, Gamkrelidze I, Nguyen MH, et. al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study[J]. Lancet Gastroenterol Hepatol, 2018, 3(6): 383-403.
[2] Liu J, Liang W, Jing W, et. al. Countdown to 2030: eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238.
[3] Rongshou Z, Chunfeng Q, Siwei Z, et. al. Liver cancer incidence and mortality in China: Temporal trends and projections to 2030[J]. Chin J Cancer Res, 2018, 30(6): 571-579.
[4] 王贵强, 王福生, 庄辉, 等. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669.
[5] 丁惠国, 屠红, 曲春枫, 等. 原发性肝癌的分层筛查与监测指南(2020版)[J]. 临床肝胆病杂志, 2021, 37(2): 286-295. doi: 10.3969/j.issn.1001-5256.2021.02.009
[6] 鲁俊锋, 侯维, 马丽娜, 等. 富马酸丙酚替诺福韦初始治疗慢性乙型肝炎患者的早期疗效[J]. 中国肝脏病杂志(OL), 2020, 12(3): 29-33.
[7] 林畅琪. 慢性乙型肝炎患者发生病毒学突破和病毒学应答的影响因素分析[D]. 广州: 广东药科大学, 2019.
[8] 周珲堃, 江建宁, 苏明华, 等. 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[J]. 临床肝胆病杂志, 2022, 38(3): 532-536. doi: 10.3969/j.issn.1001-5256.2022.03.008
[9] Chan HL, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg positive chronic hepatitis B virus infection: a randomised, doubleblind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1(3): 185-195.
[10] Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1(3): 196-206.
[11] 任天棋, 杨倩倩, 马鹤铭, 等. TAF治疗慢性乙型肝炎的研究进展[J]. 肝脏, 2019, 24(11): 1319-1322. doi: 10.3969/j.issn.1008-1704.2019.11.037
[12] 肖芷琪, 周福元, 周彬, 等. 慢性乙型肝炎患者的基线丙氨酸氨基转移酶水平与抗病毒疗效的关系[J]. 南方医科大学学报, 2019, 39(2): 150-155.
[13] 周珲堃, 江建宁, 苏明华, 等. 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[J]. 临床肝胆病杂志, 2022, 38(3): 532-536. doi: 10.3969/j.issn.1001-5256.2022.03.008
[14] Hu P, Shang J, Zhang W, et al. HBsAg loss with peg-interferon alfa-2a in hepatitis B patients with partial response to nucleos (t) ide analog: new switch study[J]. J Clin Transl Hepatol, 2018, 6(1): 25-34.
[15] 傅维佳, 李成忠. 核苷(酸)类药物长期治疗HBeAg阳性慢性乙型肝炎患者血清HBsAg、HBeAg和HBV DNA动态变化及应答相关性[J]. 肝脏, 2018, 23(2): 114-117.
[16] 王培培. 慢性乙型肝炎患者恩替卡韦治疗后病毒学应答的影响因素分析[J]. 中国实用医刊, 2021, 48(13): 60-64.
[17] 李明慧, 胡蕾苹, 张璐, 等. HBEAG阳性慢性乙型肝炎用核苷(酸)类似物治疗部分病毒学应答患者转换聚乙二醇干扰素α-2A治疗的研究[J]中华肝脏病杂志, 2015, 23(11): 826-831. doi: 10.3760/cma.j.issn.1007-3418.2015.11.006
[18] 阎文昭, 张岩, 刘英辉, 等. 血清HBsAg和HBeAg定量检测对HBeAg阳性慢性乙型肝炎患者病毒学应答的预测价值[J]. 国际流行病学传染病学杂志, 2016, 43(3): 177-181.
[19] 白一春, 邓霁红, 梅小平. 影响聚乙二醇干扰素α-2B治疗慢性乙型肝炎患者疗效的多因素分析[J]. 实用肝脏病杂志, 2019, 22(4): 490-493. doi: 10.3969/j.issn.1672-5069.2019.04.010
[20] 吕月, 安子英, 李艳伟. 等. HBSAG/抗-HBS双阳性慢性乙型肝炎患者的临床和病毒学特点[J]. 中国病毒病杂志, 2017, 7(1): 23-26.
[21] Wang Q, Hu L, Ding D, et al. Upgrade Combination Response Is Limited by Prolonged Nucelos(t)ide Analogue Therapy in HBeAg-positive Chronic Hepatitis B: A Real-life Study[J]. J Clin Transl Hepatol, 2018, 6(1): 11-17.
[22] 陈琦琪, 程澄, 王京京, 等. 恩替卡韦应答不佳的HBeAg阳性慢性乙型肝炎患者的基线特征研究[J]. 中华实验和临床病毒学杂志, 2019(4): 415-418.
[23] Terrault NA, Lok AF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599.
[24] 周子凡. HBeAg阳性慢性乙型肝炎患者恩替卡韦治疗48周病毒学不完全应答早期预测因素研究[D]. 沈阳: 中国医科大学, 2021.
[25] 王素娜, 连建奇, 贾战生, 等. 富马酸丙酚替诺福韦治疗慢性乙型肝炎的研究现状[J]. 临床肝胆病杂志, 2019, 35(8): 1828-1833.
[26] 胡璇, 李彤, 王玉珊, 等. 丙酚替诺福韦治疗慢性乙型肝炎的临床研究进展[J]. 胃肠病学和肝病学杂志, 2021, 30(8): 950-954.
[27] 朱云竹. 富马酸丙酚替诺福韦对慢性乙型肝炎初治及经治患者的疗效及安全性分析[D]. 合肥: 安徽医科大学, 2022.
[28] European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398.
-
下载:
图(4)
计量
- 文章访问数: 963
- PDF下载数: 383
- 施引文献: 0