The Effect Of Telbivudine Antiviral Therapy On Curative Effect Observation In Patients With Hepetitis B E Antigen-positive Chronic Hepatitis B

Background:There are about350million people worldwide infected with HBVchronically,and accounts for annually about1million deaths from fulminant hepatitis,liver failure,liver cirrhosis,liver cancer and other serious complications.Belongs tothe high prevalence of hepatitis B area in our country, the positive rate of hepatitis Bsurface antigen (HBsAg) is about7.18%, that is93million people infected withchronic hepatitis B virus,and about20million people are chronic hepatitis Bpatients.So it is an important and difficult task to prevent and manage individualswith CHB in our country.Telbivudine(LdT) is a nucleoside antiviral drugsappeared on the market since2006,with the role of specific and potent inhibition ofHBV-DNA,work quickly,small side effects, lower clinical resistance,and it caneffectively improve liver histology.The drug can improve patients with glomerularfiltration rate,which were metabolized in kidney.and it has potent inhibition of viralreplication, higher HBeAg serologic conversion rate compared with other oralantiviral drugs.Objective:Through follow-up for2years regularly,observe the effect from biochemi-stry and pathology in patients with HBeAg positive chronic hepatitis B before andafter LdT treatment,and total HBV DNA in the liver tissue were observed before andafter treatment and the change of cccDNA,comprehensive assess the effect of LdTantiviral therapy.Methods:We collected clinical datas of24patients with HBeAg positive chronic hepatitis B in the first hospital of jilin university who participated in“Telbivudine antiviraltreatment for clinical research plan reach a length of2years”between October2009and March2012.All cases received600mg of LdTdaily for104weeks.Baselineclinical datas were recorded such as age,sex,body mass index,genotyping,etc,thepatients’ baseline of liver and kidney function,blood routine,coagulation routine,creatine kinase,AFP,Fibroscan,HBsAg,HBeAg,HBV DNA titre and other indicatorswere monitored and recorded.Before treatment to take liver biopsy in histologicalgrading and liver total of HBV DNA and cccDNA quantitative detection.Aftertreatment,we recorded each phase of the liver and kidney function, blood routine,creatine kinase, HBsAg, HBeAg, HBV DNA titre in12w、24w、36w、52w、64w、76w、88w and104w, and discontinuous recorded clinical indexes such as AFP,Fibroscan and blood coagulation routine to get the response outcome.At the end oftreatment, take another liver biopsy in histological grading and liver total of HBVDNA and cccDNA quantitative detection.Results:LdT treatment can promote liver function recovery in the short term, in thetreatment of52weeks and104weeks there was statistical significance differencescompared with the baseline(P<0.001).Compared with the baseline,the HBsAg,HBeAg, HBV DNA titer was decreased obviously before and after treatment,thedifference was statistically significant(P<0.05).HBeAg and HBV DNA serologicnegative conversion rate together with virological breakthrough ratewas increased slowly as the extension of treatment time,there was no virologicalbreakthrough in the short term.The liver tissue inflammation activity level andfibroscan values was improved,before and after treatment the difference wasstatistically significant(P<0.001),while little change in fibrosis score(P=0.3824).Comp-ared with the baseline,95.7%patients with HBV DNA and91.3%withcccDNA content of liver tissue descend,the difference was statisticallysignificant(P<0.001). The serum HBsAg,HBeAg,HBV DNA was significantlypositively related to total HBV DNA in liver tissue(P<0.001),whereas cccDNA no significant correlation.Conclusion:1. LdT antiviral therapy can improve liver function and make it back to normal, andinhibit HBV DNA’s replication within a short time,meanwhile,it has good safetyfor using a long time.2. LdT can improve patient’s renal function, increase the glomerular filtration rate.3. LdT has higher HBeAg and HBV DNA serologic negative conversion rate at104weeks, but we must need to monitor the gene mutation locus.4. LdT can significantly improve the liver tissue inflammation activity level but notfibrosis of chronic hepatitis B patients at104weeks,therefore we advocateantiviral and anti fibrosis drug combination.5. LdT treatment can obviously reduce the total content of HBV DNA andcccDNA in liver tissue at104weeks,but it doesn’t can eliminate cccDNA, thepatients still need longer treatment time.6. The serum HBsAg, HBeAg, HBV DNA was significantly positively related tototal HBV DNA in liver tissue, whereas cccDNA no significant correlation.