富马酸丙酚替诺福韦治疗特殊慢性乙型肝炎的相关进展

宋玉文; 沙丽丽; 陈立震; 李梦昆; 王玉荣; 辛永宁

doi:10.3969/j.issn.1001-5256.2023.01.024

富马酸丙酚替诺福韦治疗特殊慢性乙型肝炎的相关进展

DOI: 10.3969/j.issn.1001-5256.2023.01.024

1.
青岛大学附属青岛市市立医院感染性疾病科，山东青岛 266011
2.
南京医科大学附属青岛临床医学院，南京 210000

基金项目:

慢性乙肝临床研究项目 (IN-CN-320-5837)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：宋玉文负责查阅文献，撰写文章；沙丽丽、李梦昆、王玉荣参与论文起草；陈立震参与起草、修改文章关键内容；辛永宁参与指导，修改撰写文章并最后定稿。

详细信息

通信作者:
辛永宁，xinyongning@163.com (ORCID: 0000-0002-3692-7655)

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出版历程
- 收稿日期: 2022-07-15
- 录用日期: 2022-09-19
- 出版日期: 2023-01-20

Research advances in tenofovir alafenamide fumarate in treatment of special chronic hepatitis B

1.
Department of Infectious Diseases, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong 266011, China
2.
Qingdao Clinical Medical College Affiliated to Nanjing Medical University, Nanjing 210000, China

Research funding:

Chronic Hepatitis B Clinical Research Project (IN-CN-320-5837)

More Information

Corresponding author: XIN Yongning, xinyongning@163.com(ORCID: 0000-0002-3692-7655)

摘要

摘要: 我国HBV感染人数众多，严重危害公共卫生安全。富马酸丙酚替诺福韦(TAF)作为临床一线用药，具有强效、低耐药、骨肾安全等特点。本文归纳总结了TAF在低病毒血症、多重耐药、妊娠期、肝衰竭及肝移植等特殊类型慢性乙型肝炎患者中的作用，分析表明TAF能够降低低病毒血症患者病毒载量实现病毒学应答、为耐药患者提供新方案、阻断母婴传播、降低终末期肝病患者病死率、改善慢性肾脏病患者肾功能。
- 慢性乙型肝炎 /
- 乙型肝炎病毒 /
- 富马酸丙酚替诺福韦 /
- 治疗学
Abstract: There are a large number of individuals with HBV infection in China, which seriously endangers public health safety. As a first-line drug used in clinical practice, tenofovir alafenamide fumarate (TAF) has the characteristics of strong efficacy, low drug resistance, and bone and kidney safety. This article summarizes the role of TAF in patients with special types of chronic hepatitis B, such as low-level viremia, multidrug resistance, pregnancy, liver failure, and liver transplantation, and the analysis shows that TAF can reduce viral load in patients with low-level viremia to achieve virologic response, provide new regimens for patients with drug resistance, block mother-to-child transmission, reduce the mortality rate of patients with end-stage liver disease, and improve renal function in patients with chronic kidney disease.
- Hepatitis B, Chronic /
- Hepatitis B virus /
- Tenofovir Alafenemide Fumarate /
- Therapeutics

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表 1 TAF在LLV患者中的疗效

Table 1. Efficacy of TAF in patients with LLV

学者	治疗方案	治疗周期	基线期LLV例数	治疗后HBV DNA＜20 IU/mL	HBeAg转阴	ALT复常率(≤40 U/L)
Ogawa E^[10]	ETV换TAF	48周	34	97.1%(33/34)	-	-
	NUC换TAF		9	77.8%(7/9)	-	-
Ogawa E^[11]	ETV换TAF	96周	34	97.1%(33/34)	-	-
	TDF换TAF		7	71.4%(5/7)	-	-
	NUC换TAF		10	80%(8/10)	-	-
Li ZB^[12]	ETV换TAF	12周	75	54.7% (41/75)	3.9% (2/51)	42.9%(9/21)
	继续ETV		75	6.7% (5/75)	1.9%(1/52)	10.5%(2/19)
	ETV换TAF	24周	75	62.7% (47/75)	7.8%(4/51)	47.6%(10/21)
	继续ETV		75	9.3% (7/75)	3.8%(2/52)	10.5%(2/19)
Yan D^[13]	ETV换TAF	12周	104	41.8%¹⁾	-	91.8%
	继续ETV		395	8%¹⁾	-	82.8%
	ETV换TAF	24周	104	79.4%¹⁾	-	92.6%
	继续ETV		395	9.1%¹⁾	-	80.6%
注：1)治疗后HBV DNA＜30 IU/mL患者占比。

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表 2 妊娠期CHB患者抗病毒治疗效果汇总

Table 2. Efficacy of antiviral therapy in pregnant CHB patients

学者	治疗方案	患者例数	开始应用药物的孕周(周)	基线期HBV DNA(log₁₀ IU/mL)	分娩时HBV DNA(log₁₀ IU/mL)	婴儿人数	母婴传播率(%)
Zeng QL^[17]	TAF组	116	28	7.8±0.7	3.5±0.9	117	0
	TDF组	116	28	7.8±0.7	3.4±1.0	116	0
Li B^[18]	TAF组	36	24	7.95±0.40	3.51±0.61	36	0
	TDF组	36	24	7.85±0.41	3.45±0.59	36	0
Ding Y^[19]	TAF组	71	27	7.78±0.72	4.09±1.12	73	0
Chen R^[20]	TAF组	98	47例孕早期、51例孕中期	7.07±0.91	4.09±1.12	98	0
Zeng QL^[21]	TAF组	103	1.3(±14.6)	5.1±3.4	1.2±1.7	102	0
	TDF组	104	1.0(±12.3)	4.6±3.4	0.9±1.4	103	0
Zhu YX^[22]	TAF组	51	24~28	8.07±8.10	3.43±1.30(下降水平)	-	0
	TDF组	51	24~28	8.06±8.13	3.70±0.91(下降水平)	-	0

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