目的：探讨弹性测量值评估慢性乙型肝炎肝纤维化程度的临床价值及其影响因素。方法根据血清ALT、TBIL水平分为ULN)，l×ULN<<2×ULN和≥2×ULN 3组；根据年龄分<40岁与≥40岁两组，分析F值是否受年龄、ALT、TBIL的影响。其中32例患者在1周内行肝穿刺活检，并对肝纤维化程度进行分期，采用Kruskal-Wallis检验比较不同肝纤维化分期间F值的差异，评价F值判断肝纤维化程度是否有效。用Spearman等级相关关系检验F值与肝纤维化的相关关系。结果根据年龄、ALT、TBIL分组的F值的平均数分别为：8.39±6.41、11.81±8.79 Kpa；8.05±5.47、10.88±8.4、12.94±10.38 Kpa；8.35±5.69、11.39±9.13、20.22±13.26Kpa。32例行肝穿刺者不同肝纤维化分期F值比较，差异有统计学意义（P<0.05），经Spearman等级相关分析显示，F值与肝纤维化分期呈正相关（r=0.78，P<0.05）。结论 F值与肝脏病理纤维化分期呈正相关， Hepatest对乙型肝炎肝纤维化具有较好的诊断价值。

Objective To investigate the clinical value of elasticity measurements to assess the degree of liver fibrosis in chronic hepatitis B and its relationship with age,ALT,TBIL''s. Methods Patients with chronic hepatitis B from December 2013 to April 2014 the ninth hospital in Nanchang for the study of 364 cases,cirrhosis of the liver ultrasound detector (Hepatest) detection of liver elasticity measurement value(F),all simultaneous detection of liver function in patients,according to serum ALT,TBIL were divided into<1×upper limit of normal (ULN),1×ULN<<2×ULN and≥2×ULN3 group;according to the age of <40 years and ≥40 years of age two group. 32 patients within 1 week of liver biopsy,and staging of liver fibrosis,using kruskal-wallis test to compare the value of different liver fibrosis F differences during the evaluation to determine the degree of liver fibrosis F value is valid. Spearman rank correlation test using the correlation between F value and liver fibrosis. Results A

目的探索在ALT〈2倍正常值上限（2×ULN）的慢性HBV感染人群中,一般临床指标对肝脏病理结果的预测作用。方法收集2009年1月至2013年6月新乡医学院第一附属医院收治的122例ALT〈2×ULN的慢性HBV感染者,在超声引导下行肝穿刺活组织检查术,判断肝组织炎症活动度及纤维化程度,同期化验肝功能、乙型肝炎血清标志物、HBV DNA等指标,应用Logistic回归分析法探索该类患者的一般临床指标对其肝脏病理结果的预测作用。结果 122名患者中有明显炎症或纤维化（G≥2或S≥2）者共94例（77.0%）,早期肝硬化者5例（4.1%）。G〈2组与G≥2组相比,除HBV DNA外,其余各指标间差异均无统计学意义;S〈2组与S≥2组相比,年龄、HBeAg、HBV DNA、AST、血小板差异均有统计学意义;Logistic回归分析提示,年龄、HBeAg和AST是肝脏明显纤维化（S≥2）的独立预测因子。结论对血清ALT〈2×ULN的慢性HBV感染者,年龄〉40岁、HBeAg阴性、AST〉40U/L者应积极进行肝穿刺活组织检查术,必要时尽早抗病毒治疗。

Objective To investigate the role of various clinical parameters in predicting liver injury stage in patients with chronic hepatitis B virus (HBV)infection who had alanine aminotransferase (ALT)levels lower than 2 times the upper limit of normal (ULN).Methods Ultrasound-guided liver biopsy was performed in chronic HBV infection patients with ALT levels lower than 2 ×ULN.The activity of in-flammation and degree of fibrosis in liver tissues were assessed.Meanwhile,liver function,serum HBV markers,and HBV DNA were meas-ured.The role of these clinical parameters in predicting liver injury stage was evaluated by logistic regression analysis.Results Among 122 patients,94 (77.0%)had significant inflammation or fibrosis (G≥2 or S≥2),and 5 (4.1%)had early cirrhosis.There was significant difference in HBV DNA between G≥2 group and G 40 U/L.

目的 观察国产恩替卡韦治疗慢性乙型肝炎的临床疗效并评估影响疗效的因素.方法 应用国产恩替卡韦治疗浙江省绍兴市第六人民医院2010年12月至2012年12月门诊或住院200例慢性乙型肝炎患者,分别于12、24、48周进行病毒学、血清学及生化学指标的检测,并将包括乙型肝炎e抗原(HBeAg)阳性或阴性、基线丙氨酸转氨酶(ALT)水平、乙型肝炎病毒脱氧核糖核酸(HBV DNA)转阴时间、基线HBV DNA水平及肝组织病理特征等因素对疗效的影响进行评估.结果 国产恩替卡韦治疗48周,ALT复常率为78.5％ (157/200),HBV DNA转阴率为84.5％(169/200),HBeAg血清转换率23.4％(33/141,耐药率为0％;基线ALT ＞5倍正常值上限(ULN)患者的HBeAg血清学转换率高于2～5 ULN的患者[分别为35.4％ (19/54)和16.1％(14/87),P＜0.05];治疗24周后HBV DNA阴转的患者与未阴转的患者相比,其48周HBV DNA阴转、ALT复常和HBeAg血清学转换的比例明显增高[分别为92.4％(134/145)、86.2％(125/145)、20.7％ (30/145)和63.6％ (35/55)、58.2％(32/55)、5.5％(3/55),均P＜0.05];炎症活动分级(G)＞2,HBeAg血清转换率高于G≤2[分别为37.5％(12/32)和15.0％(3/20),P＜0.05];基线病毒载量高低与48周疗效差异无统计学意义(P＞0.05).在治疗48周过程中8例发生一过性ALT升高,无患者因发生不良事件而停药.结论 国产恩替卡韦能明显抑制HBV DNA复制,促进ALT复常及HBeAg血清转换,有效改善肝功能,耐药率低,安全性良好.且基线ALT＞5 ULN、炎症活动分级G＞2及治疗24周后HBV DNA阴转的患者在48周时有更好的疗效.

Objective To investigate the effect of domestic entecavir on chronic hepatitis B.Methods The virology,serology and biochemical indicators of 200 patients who received entecavir for the treatment of chronic hepatitis B were analyzed before treatment and 12,24 and 48 weeks after treatment.Results After 48 weeks of treatment,hepatitis B virus(HBV) DNA negative rate was 84.5％ (169/200) ; hepatitis B e antigen(HBeAg) seroconversion rate was 23.4％ (33/141) ; alanime transaminase (ALT) normolization rate was 78.5％ (157/200)and drug resistant rate was 0.The rate of HBeAg seroconversion in patients with baseline ALT ＞ 5 ULN was significantly higher than tht in patients with 2 to 5 ULN[35.4％ (19/54) vs 16.1％ (14/87),P ＜0.05].Compared with patients with no HBV DNA negative conversion at 24 weeks,ratio of HBV DNA negative conversion,ALT normalization and HBeAg seroconversion were significantly higher in patients with HBV DNA negative 48 weeks after treatment [92.4％ (134/145) vs 6

目的 了解恩替卡韦、阿德福韦酯单药治疗血清ALT水平为正常值上限(ULN)的1～2倍、HBeAg阴性慢性乙型肝炎患者的临床疗效.方法 前瞻性观察我院应用恩替卡韦和阿德福韦酯治疗的ALT水平为ULN的1～2倍、HBeAg阴性中年慢性乙型肝炎患者的疗效.其中60例为恩替卡韦组,47例为阿德福韦酯组,剂量为恩替卡韦0.5 mg/d、阿德福韦酯10 mg/d,疗程至少96周.32例患者治疗前接受肝穿刺组织病理学检查.治疗过程中每3个月监测1次ALT、HBV DNA水平,同时观察药物不良反应及耐药性.结果 失访6例,其中恩替卡韦组4例、阿德福韦酯组2例.治疗前行肝穿刺组织病理学检查的35例患者中,30例(86％)有明显的肝组织炎症(≥G2)或肝纤维化(≥S2).96周时,ALT复常率阿德福韦酯组和恩替卡韦组分别为67％(30/45)、95％(53/56),两组差异有统计学意义(x2=13.33,P＜0.01);HBV DNA水平低于检测值下限率阿德福韦酯组和恩替卡韦组分别为78％(35/45)、100％(56/56)(x2=13.81,P＜0.01).恩替卡韦组未发现耐药病例,阿德福韦酯组耐药率4％ (2/45).治疗过程中两组均未发现与恩替卡韦及阿德福韦酯相关的药物不良反应.结论 ALT水平为ULN的1～2倍、HBeAg阴性慢性乙型肝炎患者大部分有较明显肝脏炎症或纤维化,恩替卡韦治疗的临

Objective To evaluate the clinical efficacy of entecavir (ETV) or adefovir dipivoxil (ADV) monotherapy in treatment of HBeAg-negative chronic hepatitis B (CHB) patients with mildly elevated ALT.Methods One hundred and seven HBeAg-negative CHB patients with ALT elevated by 1-2-fold of upper limit of normal (ULN) were enrolled in this prospective study.Sixty patients were assigned to receive ETV monotherapy and 47 patients to receive ADV monotherapy for at least 96 weeks.The ALT and HBV DNA levels were measured every 3 months.The liver biopsy was performed in 35 patients prior to therapy.Drug resistance and adverse reactions were documented.Results Four cases in ETV group and 2 cases in ADV group were lost in follow-up.Among 35 patients with liver biopsy,30 (86％) cases had significant fibrosis (stage 2-4) or inflammation (grade 2-4).At weeks 96,serum ALT was normalized in 67％ (30/45) cases of ADV group,and 95％ (53/56) cases of ETV group (x2 =13.33,P ＜ 0.01) ; the proportion

目的观察恩替卡韦分散片治疗慢性乙型肝炎患者的疗效和安全性。方法未经过抗病毒治疗的慢性乙型肝炎患者194例进行回顾性分析,予以恩替卡韦分散片0.5mg,口服每日1次,分别检测治疗0、4、12、24、48、72周时患者血清的乙型肝炎病毒脱氧核糖核酸(HBV-DNA)水平、表面抗原(HBsAg)与e抗原(HBeAg)状态和肝功能情况,同时观察治疗过程中药物的安全性。结果恩替卡韦分散片治疗至72周时HBV-DNA水平平均下降幅度达到3.60log10,HBV-DNA未检出率达到96.37%,谷丙转氨酶(ALT)复常率达到97.93%;HBeAg和HBsAg血清学转换率为7.81%和3.13%;治疗前基线ALT水平5ULN组HBV-DNA阴转率和HBeAg转阴率明显高于ALT 2~5ULN组和ALT2ULN组,差异有统计学意义(P0.01),HBeAg转换率与ALT2ULN组比较差异有统计学意义(P0.01);HBV-DNA107 copies/ml组在HBV-DNA阴转率、HBeAg转阴率及转换率方面均高于HBV-DNA107~108 copies/ml组和HBV-DNA108 copies/ml组,差异有统计学意义(P0.05),HBeAg转阴率与HBV-DNA108 copies/ml组,差异有统计学意义(P0.01)。结论恩替卡韦分散片治疗慢性乙型肝炎患者在抑制病毒复制、提高HBeAg血清转换率方面均有疗效,且安全有效。

OBJECTIVE To observe the efficacy and safety of entecavir in treatment of the patients with chronic hep-atitis B .METHODS Totally 194 patients with chronic hepatitis B who did not receive the antiviral therapy in the Zhejiang University of Traditional Chinese Medicine Affiliated the sixth Hospital of Hangzhou were retrospectively reviewed ,then the subjects were given 0 .5 mg of entecavir dispersible tablet ,oral administration ,once per day ;the serum HBV-DNA level ,HBsAg and HBeAg content ,and liver function were determined at week 0 ,4 ,12 , 24 ,48 and 72 of treatment ,and the safety of use of drugs was observed .RESULTS At week 72 of the treatment with entecavir dispersible tablet ,the HBV-DNA level deceased by 3 .60 log10 ,96 .37% were detected negative for HBV-DNA ,the recovery rate of alanine aminotransferase (ALT ) reached 97 .93% ;the seroconversion rates of HBeAg and HBsAg were 7 .81% and 3 .13% ,respectively .The negative rates of the HBV-DNA and HBeAg were significantly hig