艾米替诺福韦和富马酸替诺福韦对治疗乙肝肝纤维化的临床疗效比较

doi:10.3969/j.issn.1006-5725.2024.22.016

Abstract

Abstract:

Objective This study is to explore the clinical efficacy and common adverse reactions of PEG?IFN α ?2b combined with TMF and TDF in the treatment of hepatitis B liver fibrosis， and provide more clinical reference for the treatment of chronic hepatitis B. Methods From January 2022 to December 2023， we selected 130 patients with chronic hepatitis B liver fibrosis who were admitted to Kunming Third People's Hospital. Divided into TMF combined group and TDF combined group， the virus reduction level， virus response rate， liver fibrosis four items， instantaneous elastography （FibroScan） and other indicators were compared between the two groups of patients after 48 weeks of treatment. The changes in liver fibrosis grading and adverse reactions before and after treatment were also compared. Results After 48 weeks of treatment， the TMF combined group showed a significant increase in HBV DNA seroconversion rate and HBeAg seroconversion rate compared to the TDF combined group， with statistical significance （P < 0.05）. However， there was no statistically significant difference in HBsAg seroconversion rate between the two groups of patients （P > 0.05）. After 48 weeks of treatment， the TMF combined group showed more significant efficacy in reducing the levels of HA， PC Ⅲ， Ⅳ?C， and LN， with a significant difference （P < 0.05）； After 48 weeks of treatment， both groups of patients showed improvement in the degree of liver tissue fibrosis. Compared with the TDF combined group， the TMF combined group had a more significant effect on tissue improvement. After 48 weeks of treatment， the incidence of dyslipidemia， hypothyroidism， and diarrhea was higher in the TMF combined group than in the TDF combined group （P < 0.05）； After 48 weeks of treatment， there was no statistically significant difference in the incidence of gingival bleeding， anemia， and thrombocytopenia between the two groups of patients （P > 0.05）； The incidence of elevated uric acid and joint pain in the TDF combined group was higher than that in the TMF combined group after 48 weeks of treatment （P < 0.05）. Conclusion TMF combined with PEG?IFN α ?2b has better clinical efficacy in treating chronic hepatitis B， strong antiviral ability， greater inhibition of liver fibrosis， good drug safety， better prognosis， and can provide more effective medication basis for clinical cure of hepatitis B.

Key words: tenofovir amibufenamide, tenofovir disoproxil fumarate, interferon, clinical efficacy, liver fibrosis

CLC Number:

R512.6+2

Yingyuan ZHANG,Chunyan MOU,Danqing XU,Yuanzhen WANG,Lixian CHANG,Chunyun LIU,Weikun LI,Hongyan WEI,Li LIU. Comparison of clinical efficacy of TMF and TDF in the treatment of hepatitis B liver fibrosis[J]. The Journal of Practical Medicine, 2024, 40(22): 3215-3220.

Figures/Tables 7

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References 23

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临床特征	TMF联合治疗组	DTF联合治疗组	t/χ²值	P值
性别/例
男	39	36
女	26	29
年龄（x ± s）/岁	35.71 ± 13.32	36.89 ± 13.58	4.004	0.484
HBVDNA（x ± s）/（× 10⁵ IU/mL）	1.31 ± 3.47	1.16 ± 4.72	0.210	0.841
HBsAg（x ± s）/（IU/mL）	7 244.01 ± 16 962.87	9 261.49 ± 15 272.96	-0.713	0.885
HBeAg（x ± s）/（IU/mL）	84.40 ± 133.037	68.30 ± 116.29	0.734	0.584
透明质酸（x ± s）/（ng/mL）	182.00 ± 120.36	176.55 ± 107.37	0.272	0.732
Ⅲ型胶原N端肽（x ± s）/（ng/mL）	34.72 ± 27.04	26.62 ± 33.32	1.521	0.701
Ⅳ型胶原（x ± s）/（ng/mL）	113.53 ± 83.86	135.17 ± 96.08	-1.368	0.210
层粘连蛋白（x ± s）/（ng/mL）	170.77 ± 99.37	153.77 ± 124.97	0.859	0.583
瞬时弹性成像（x ± s）/KPa	11.07 ± 3.05	10.61 ± 2.86	0.888	0.410

组别	例数	DNA转阴率	HBsAg转阴率	HBeAg血清学转换率
TMF联合组	65	62（95.4）	16（24.6）	19（29.2）
TDF联合组	65	59（90.8）	15（23.1）	8（12.3）
χ²值		4.188	0.042	5.656
P值		0.041	0.837	0.017

组别	时间（48周）	HA	PC ⅢP	Ⅳ-C	LN
TMF联合组（n = 65）	治疗前	182.00 ± 120.36	34.72 ± 27.04	113.53 ± 83.86	170.77 ± 99.37
	治疗后	107.70 ± 71.57	22.37 ± 14.30	80.40 ± 48.70	144.58 ± 98.42
TDF联合组（n = 65）	治疗前	176.55 ± 107.37	26.62 ± 33.32	135.17 ± 96.08	153.77 ± 124.97
	治疗后	142.69 ± 100.31	16.56 ± 15.87	99.55 ± 65.50	114.89 ± 77.16
t/P值TMF联合组（治疗前后）		5.212/< 0.05	4.118/< 0.05	4.260/< 0.05	2.935/< 0.05
t/P值TDF联合组（治疗前后）		2.580/< 0.05	3.080/< 0.05	3.089/< 0.05	3.523/< 0.05
t/P值组间值（治疗后）		2.447/< 0.05	2.230/< 0.05	2.443/< 0.05	2.137/< 0.05

组别	例数	治疗前					治疗48周后					Z值	P值
组别	例数	F0	F1	F2	F3	F4	F0	F1	F2	F3	F4	Z值	P值
TMF联合组	65	10	15	17	19	4	32	32	4	6	2	-6.075	< 0.05
TDF联合组	65	11	20	18	14	2	20	25	9	9	2	-4.023	< 0.05
Z值			-1.236					-2.138
P值			0.216					0.033

组别	例数	血脂异常	甲功能异常	腹泻	牙龈出血	贫血	血小板减少	尿酸升高	关节痛
TMF联合组	65	22（33.8）	16（24.6）	15（23.1）	10（15.4）	7（10.8）	10（15.4）	5（7.7）	8（12.3）
TDF联合组	65	10（15.4）	8（12.3）	8（12.3）	11（16.9）	8（12.3）	12（18.5）	16（24.6）	15（23.1）
χ ² 值		-2.482	2.673	-1.613	0.237	0.272	0.456	-1.817	1.613
P值		< 0.001	< 0.001	0.001	0.637	0.586	0.353	< 0.001	0.001

Comparison of clinical efficacy of TMF and TDF in the treatment of hepatitis B liver fibrosis

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