| Objective:To evaluate the efficacy of TDF initial treatment and treatment in CHB patients,and the efficacy of ADV in naschb-resistant patients treated with TDF and NAsCHB alone,and to evaluate the effect of TDF on renal function.Methods:this study collected 90 CHB patients from the outpatient department of infectious diseases of zhejiang provincial people’s hospital from January 2012 to August 2016,among whom 42 were patients with liver puncture.The diagnostic criteria were in accordance with the guidelines for the prevention and treatment of chronic hepatitis b(2015 edition).The study was approved by the ethics committee,and the patients and their families had the right to know about the study.30 patients(group A)were initially treated with TDF(qingzhen,300mg/qd),and 60 patients(group A)with drug resistance or poor response to NAs treatment(group B)were changed to TDF(group B),except 30 patients(group C)who were treated with ADV(minzheng,10mg/qd).Respectively(baseline)before treatment,treatment of 4 weeks,8 weeks,12 weeks and 24 weeks,48 weeks and 72 weeks and 96 weeks monitoring baseline HBVDNA genotype,different time points in HBV-DNA quantitative and hepatitis b,three quantitative,and biochemical testing different time points,creatinine,creatinine clearance,sensitive kidney,blood,blood calcium,phosphorus,routine blood,PT,etc.Results:The HBVDNA in patients with baseline value differences between the three groups(P>0.05),as the treatment progresses,tend to gradually reduce,in the 96th week compared with baseline values were significantly different(P<0.05),and the NAs+ADV HBVDNA level higher than that of TDF group(P<0.05),but at this time of two groups of patients with HBVDNA overcast rate there is no difference(P>0.05).Total bilirubin(TBIL between groups),propagated(albumin),BUN(blood urea nitrogen)and SCr(serum creatinine)baseline value no difference(P>0.05),as the treatment progresses,has the certain change,but the 96th week besides TBIL,the rest of the indicators and the baseline value no difference(P>0.05),and the NAs+ADV level of liver and kidney function index and TDF group no difference(P>0.05).There was no difference in the baseline level of ALT between groups(P>0.05).With the decrease of treatment,there was a significant difference from the baseline value at 96 weeks(P<0.05).At this time,the ALT level of the NAs+ADV group was higher than that of the TDF group(P<0.05),but there was no difference in the ALT renormal rate between groups(P>0.05).At the 96th week,the negative conversion rates of HBeAg in the TDF group and the NAs+ADV group were 33.33%(20/60)and 26.67%(8/30),and the serological conversion rates of HBeAg were 25%(15/60)and 20%(6/30),respectively,with no significant difference between the groups(P>0.05).The drug resistance rate was 0%in the TDF group and 13.33%in the NAs+ADV group,with no statistically significant difference(P>0.05).The incidence of adverse reactions was 11.67%in the TDF group and 20%in the NAs+ADV group,and there was no significant difference in the incidence of adverse reactions between the groups(X2=1.1239,P=0.289).Conclusion:1.Tenofovir dipivoxil(TDF)is more effective in inhibiting HBV replication in patients with poor initial and treatable responses or drug-resistant chronic hepatitis b.Antiviral therapy is provided for patients with poor clinical response or drug resistance to chronic hepatitis b.2.There were some changes in renal function during the observation period of TDF,and eGFR levels of patients in the three groups all showed a decreasing trend during the treatment.However,considering the economic benefits,antiviral treatment with TDF could be considered. |
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