关键词: 慢性乙型肝炎, 代偿期乙肝肝硬化, 阿德福韦酯, 恩替卡韦, 原发性肝癌

Abstract:

AIM: To evaluate the clinical efficacy and long-term prognosis of patients with compensatory hepatitis B cirrhosis treated with entecavir and adefovir dipivoxil. METHODS: One hundred and sixty patients with compensatory hepatitis B cirrhosis from January 2012 to August 2014 were randomly divided into ADV group and ETV group (80 cases in each group). Patients in ADV and ETV group were treated by entecavir and adefovir dipivoxil for antiviral therapy. The liver fibrosis index, liver fibrosis treatment efficacy, virologic indicators (HBV-DNA load, HBV-DNA negative rate and HBeAg conversion rate) before and 48 weeks after the treatment were comparatively analyzed, the long-term prognosis (3-year mortality, hepatocellular carcinoma and cirrhosis decompensation rate) in two groups were evaluated by the Kaplan-Meier survivorship curve. RESULTS: Forty-eight weeks after treatment, the fibrosis index of the treatment group were significantly lower than those before treatment, among which, those in ETV group were more obvious than ADV group［（2.91±0.90） log10 IU/mL and (2.26±0.68) log10 IU/mL, P=0.000 007 5］. The total effective rate of liver fibrosis in ADV group and ETV group were 66.25% and 81.25%, respectively (P=0.033). The HBV-DNA load reduce［（2.91±0.90） log10 IU/mL and (2.26±0.68) log10 IU/mL, P=0.000 007 5］and non-response rate of ETV group were significantly better than those of ADV group（2.50% and 11.25%，P=0.029）, the HBV-DNA negative conversion rate（86.25% and 68.75%，P=0.008） and HBeAg conversion rate were much higher than ADV group （27.50% and 11.25%，P=0.009）. The incidence of liver decompensation and all-cause mortality were significantly lower in the ETV group than those in the ADV group (43.75% and 17.50%, P=0.020，P=0.028), respectively. The incidence of liver cancer in the ADV and ETV group was 13.75% and 5.00%（P>0.05），and the risk of HCC was significantly higher in ADV group than that in ETV group［HR=2.996,95% CI (1.009,7.656), P=0.048］ . There was no significant difference between the ADV group and the ETV group in the total incidence of adverse reactions (13.75% and 11.25%, P=0.058). CONCLUSION: Compared with adefovir dipivoxil, the application of entecavir in the treatment of compensatory hepatitis B cirrhosis has better clinical efficacy and virological response, and can significantly reduce the liver cirrhosis, and improve the patient's long-term prognosis effectively.

Key words: chronic hepatitis B, compensatory hepatitis B cirrhosis, adefovir dipivoxil, entecavir, hepatocellular carcinoma