Comparison Of The Efficacy Of Tenofovir And Entecavir In The Treated Patients With Chronic Hepatitis B And Its Correlation With TCM Syndromes

Objective To compare the efficacy of tenofovir(TDF)and entecavir(ETV)in the treatment of chronic hepatitis B patients treated with single-agent salvage and its correlation with TCM syndromes,in order to provide a certain reference for the selection of anti-viral drugs for chronic hepatitis B,and to make certain predictions on the efficacy of drugs after the syndrome differentation of TCM.Method 1)We collect 69 patients with chronic hepatitis B who had poor response or resistance to nucleoside(acid)drugs(NAs)from December 2017 to January 2019 in our hospital;2)According to the treatment plan Different 39 cases were divided into TDF treatment group,30 cases of ETV control group,TDF in treatment group,300mg each time,once a day,control group takes ETV,0.5mg each time,once a day,2 hours after dinner;3)Observe it from the start of TDF or ETV treatment to the end of treatment at 48 weeks,records related indicators of the patient such as the hepatitis B three-line,HBV DNA,ALT value and occurrence of adverse events.at the 12th,24th,and 48th week before and after treatment,and history of medication,gender,age,etc.;4)According to clinical manifestations of patients of TDF treatment,dialectical classification by using four diagnostics of Chinese medicine;5)Analysis of the difference in the efficacy of TDF and ETV in treated patients with chronic hepatitis B and to explore the correlation between the efficacy of TDF and TCM syndromes.Result 1.One patient in the treatment group took the drug irregularly,and the virological response was achieved after the follow-up of the drug.2.At the follow-up endpoint,1 patient with LAM+ADV dual drug resistance and 1 ADV-resistant patient had no virological response,and other patients with drug resistance and poor response achieved virological response.In the control group,3 patients with ADV resistance achieved virological response.3.The undetectable rate of HBV DNA at each time point of 12,24,and 48 weeks was 20.0%,43.3%.66.7%in the control group and 51.3%,82.1%,and 94.9%in the treatment group.There were significant differences between the two groups,which were statistically significant(P<0.05).4.At the end of follow-up,the HBeAg conversion rate and HBeAg seroconversion rate of the treatment group and the control group were 22.9%and 11.4%,11.1%and 3.7%,respectively.There was no significant difference between the two groups(P values were 0.387,0.524,respectively).All patients' HBsAg did not disappear.5.At the 12,24,and 48 weeks,the ALT recurrence rate of the treatment group was 51.4%,85.7%,and 94.3%,respectively.The ALT recuirence rate of the control group was 42.9%,78.6%,and 82.1%,respectively.When the course of treatment is 24 weeks,most of the ALT abnormalities have basically dropped to normal levels.There were no significant difterences in serum ALT normalization rates between the two groups at each time point(P>0.05).6.In the control group,no adverse events such as lactic acidosis were recorded.In the treatment group,no serum creatinine value exceeded 2 times the upper limit of normal and blood phosphorus decreased below the lower limit of normal detection.Only one patient drug taken at bedtime developed mild nausea and vomiting gastrointestinal reactions and changed to take after dinner,the symptoms resolved spontaneously.No serious adverse reactions occurred,that need to stop the drug.7.TDF treatment group showed 20 cases of excess syndrome,8 cases of deficiency syndrome,11 cases of excess and deficiency syndrome.The undetectable rate of HBV DNA at treatment endpoints was 100%,87.5%and 90.9%,respectively.The ALT recovery rates were 100%,87.5%and 90.0%,respectively.There was ino significant difference between the three syndromes(P?0.05).Conclusion 1)Good treatment compliance is a basic prerequisite for good efficacy in CHB antiviral therapy;2)For patients with CHB who have poor response or resistance to NAs.TDF single-agent sequential therapy can still effectively inhibit viral replication,and the effect is better than ETV..When ADV genotype is resistant,TDF should be closely monitored for related indicators.Especially when LAM+ADV is dually resistant,joint antiviral therapy should be considered.ETV treatment may also be considered when ADV is resistant.TDF had no significant advantage over ETV in terms of ALT recurrence,HBeAg conversion and serological conversion.Both TDF and ETV performed well in terms of safety and tolerability;3)There is no significant correlation between the effects of TDF on viral suppression,ALT recurrence,and TCM syndromes.