Clinical effect of nucleos (t) ide analogues in treatment of acute exacerbation of chronic hepatitis B

Objective To investigate the clinical effect of nucleos (t) ide analogues (NAs) in the treatment of acute exacerbation of chronic hepatitis B (CHB) for 48 weeks. Methods The CHB patients with positive or negative HBeAg who were diagnosed and treated in Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University, from October 2014 to July 2018 were enrolled. Among these patients, 48 with an acute exacerbation of CHB and an alanine aminotransferase (ALT) level of > 10 × upper limit of normal (ULN) were enrolled as experimental group, and 51 with an ALT level of < 10 × ULN and a total bilirubin level of < 5 × ULN were enrolled as control group. Both groups were treated with entecavir and tenofovir disoproxil fumarate. The two groups were compared in terms of the clinical process and outcome of NA treatment, including baseline liver function, HBV DNA, HBsAg, anti-HBs, HBeAg, anti-HBe, and liver ultrasound findings, and follow-up was performed at weeks 12, 24, and 48 of treatment. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.Results There was a significant difference in ALT normalization rate at weeks 12, 24, and 48 of treatment between the experimental group and the control group (89. 58%/93. 75%/93. 75% vs 49. 02%/72. 55%/76. 47%, χ2= 18. 917, 7. 814, and 5. 743, all P < 0. 05) .There was a significant difference in the undetectable rate of HBV DNA at week 12 of treatment between the experimental group and the control group (83. 33% vs 60. 78%, χ2= 6. 198, P = 0. 013) , while there was no significant difference between the two groups at weeks 24 and48 of treatment (95. 83%/95. 83% vs 84. 31%/86. 27%, P > 0. 05) . There was a significant difference in HBeAg seroconversion rate between the experimental group and the control group at weeks 12, 24, and 48 of treatment (23. 26%/25. 58%/27. 91% vs 2. 22%/2. 22%/8. 89%, χ2= 8. 894, 10. 188, and 5. 346, all P < 0. 05) . Clearance or seroconversion of HBsAg was not observed in the experimental group or the control group. Conclusion NAs can achieve high ALT normalization rate, HBV DNA undetectable rate, and HBeAg seroconversion rate in the treatment of patients with acute exacerbation of CHB.