替比夫定与恩替卡韦在非霍奇金淋巴瘤合并乙型肝炎病毒感染患者化疗中的抗病毒作用研究
Comparison of antiviral effects between telbivudine and entecavirin in the chemotherapy of patients with non-Hodgkin lymphoma complicated with HBV infection
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摘要: 目的:对比观察替比夫定及恩替卡韦在非霍奇金淋巴瘤(NHL)合并乙型肝炎病毒(HBV)感染患者化疗期间抗病毒作用及不良反应。方法:NHL合并HBV感染患者50例,化疗前HBV DNA水平2×103~2×104 IU/mL,6周期环磷酰胺、多柔比星、长春新碱及强的松方案化疗同时服用替比夫定600 mg/d或恩替卡韦500 mg/d抗病毒治疗,对2种抗病毒药物间HBV再激活、病毒突破相关性肝炎突发、原发性无应答、肝衰竭、不良反应等方面进行统计分析。结果:服用替比夫定或恩替卡韦均有轻微不良反应,差异无统计学意义(P>0.05);2组患者均无原发性无应答与肝衰竭发生;2周期化疗及4周期化疗后2组HBV再激活率及肝炎突发率差异均无统计学意义(P>0.05),6周期化疗后,服用替比夫定组HBV再激活率为28.0%,肝炎突发率为32.0%,服用恩替卡韦组HBV再激活率为4.0%,肝炎突发率为8.0%,2组肝炎突发率差异有统计学意义(P<0.05)。结论:NHL合并HBV感染化疗前HBV DNA水平2×103~2×104 IU/mL的患者,口服替比夫定及恩替卡韦对预防原发性无应答及肝衰竭都有很好的效果,并且都有较好的药物安全性,但多次化疗后恩替卡韦比替比夫定有更低的肝炎突发率。Abstract: Objective: To compare the antiviral effects and adverse reactions between telbivudine and entecavirin in the chemotherapy of patients with non-Hodgkin lymphoma(NHL) complicated with hepatitis B virus(HBV) infection.Methods: The levels of HBV DNA in 50 patients with NHL complicated with HBV were from 2×103 to 2×104 IU/mL before chemotherapy.The patients were treated with cytoxan,hydroxyrubicin,oncovin and prednisone(CHOP) combined with telbivudine(600 mg/d) or entecavir(500 mg/d) for 6 cycles.The rates of reactivation of HBV replication,virological breakthrough related-hepatitis flare,primary drug nonresponse,liver failure and adverse reaction between 2 kinds of antiviral drugs treatment were compared.Results: Mild adverse events in two groups were found,the difference of which was not statistically significant(P>0.05).The primary drug nonresponse and liver failure in two groups were not found.The differences of the reactivation of HBV replication and hepatitis flare between two groups after 2 and 4 cycles of chemotherapy were not statistically significant(P>0.05).After 6 cycles of chemotherapy,the incidences of reactivation of HBV replication and hepatitis flare in the patients treated with telbivudine and entecavir were 28.0% & 32.0% and 4.0% & 8.0%,respectively.The difference of the incidence of hepatitis flare between two groups were statistically significant(P<0.05).Conclusions: The effects of telbivudine and entecavir in preventing liver failure and primary drug nonresponse in NHL complicated with HBV patients with 2×103 to 2×104 IU/mL of HBV DNA before treatment are good and safe.The hepatitis flare rate in patients treated with telbivudine is higher than that in patients treated with entecavir.
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Key words:
- hepatitis B virus /
- non-Hodgkin lymphoma /
- telbivudine /
- entecavir
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