Tenofovir Disoproxil Fumarate Therapy For Patients With Chronic Hepatitis B And The Analysis Of Influencing Factors

Background:Hepatitis B Virus infection is still an important public health problem in the world,about 1 million of patients who infected by HBV died of hepatic failure?liver cirrhosis and hepatocellular carcinoma(HCC)every year.The goal of of HBV infection treatment: to inhibit the replication of HBV maximizely,reduce hepatic fibrosis and hepatocytes inflammatory necrosis,delay the occurrence of hepatic failure,decompensated liver cirrhosis,HCC and other complications,so as to improve the quality of life and prolong the survival time,the key is to inhibit the replication of HBV.Now,TDF is considered to be the first-line treatment in Europe and the United States,because it has a strong antiviral ability and resistance safety.It is not uncommon to study the efficacy of TDF in patients with chronic hepatitis B(CHB),but it is rare to study the influencing factors of prognosis,therefore become the focus and difficulty of current research.Objective:1?To evaluate and explore the efficacy and safety of TDF for HBe Ag(+)CHB patients;2?To explore the influencing factors of TDF in the treatment of CHB patients.Methods:Using the retrospective analysis method,66 patients with HBe Ag(+)CHB treated by TDF are incorporated into the observe group,30 patients treated by ETV are incorporated into control group,from January in 2014 to January in 2017,comparing the difference of HBV DNA level?virological response?serological response and biochemical response between the two groups during the course of therapy,the observation period was 48 weeks.The observe group patients were divided into different groups by previous treatment condition,the baseline level of HBV DNA and ALT,gender and age,observing the undetective rate of HBV DNA and the serum alanineaminotransferase(ALT)normalization rate at treatment weeks 0?4?12?24?36 ?48,and HBe Ag and HBs Ag serological clear and conversion rate at teratment week 48,so as to explore the factors that influnce the efficacy of TDF.According the adverse drug reactions and laboratory results in all patients.Result:1? Comparison of efficacy between TDF group and ETV groupWith the treatment prolonged,the HBV DNA level in the two groups decreased significantly,the most robust decline in HBV DNA level was observed in the first 24 weeks,and decreased to 2.74 Ig IU/m L and 2.81 Ig IU/m L at the end of the 48 week respectively.the HBV DNA level of in TEV group was higher than the TDF group at each time point,and the difference was statistically significant at 12 weeks(P < 0.05).The conversion rate of HBe Ag in the TDF group was 16.67%,ETV group is 0.00%,and the difference was statistically significant(P=0.042)at week 48.Compared with ETV treatment,TDF treatment had higher ALT normalization rate and HBs Ag serological response rate,but the difference was not statistically significant.2?Analysis of the factors influce the efficacy of TDF treatment1)Treatment naive group and treatment experienced groupThere was no significant difference in the undetective rate of HBV DNA?ALT normalization rate?HBe Ag clearing rate and conversion rate,HBs Ag clearing rate and conversion rate between in Treatment naive group and treatment experienced group.2)High viral load group and Low viral load groupThe undetective rate of HBV DNA and ALT normalization rate in Low viral load group is higher than the high viral load group(P < 0.05),but the difference of HBs Ag and HBe Ag serological response rate is not statistically significant(P>0.05)between two groups.3)High ALT level group and Low ALT level groupFor the undetectable rate of HBV DNA,high ALT level group is higher than the low ALT level group at weeks 24,36 and 48,was statistically significant(P<0.05);For ALT normalization rate,high ALT level group is higher than the low ALT level group in weeks 24 and 36(P<0.05);and negative rate of HBe Ag was higher than the low ALT level group(P < 0.05).4)Age and Sex groupsThere was no significant difference in the virological response,biochemical response,and serological response(P >0.05)between age and sex groups.conclusion:1?For the treatment of HBe Ag(+)CHB,TDF has good clinical efficacy and safety;2?The baseline HBV DNA level can be used as influencing factors of virologic response at weeks 12 and 24;3?The baseline ALT level can be used as influencing factors of virologic response and biochemical response at weeks 24 ?36,and the HBe Ag clearing rate at week 48;4?Previous treatment condition?age and gender have nothing to do with the efficacy of TDF.