应用富马酸丙酚替诺福韦和富马酸替诺福韦二吡呋酯治疗慢性乙型肝炎患者疗效分析*

doi:10.3969/j.issn.1672-5069.2026.05.006

摘要/Abstract

摘要： 目的分析比较富马酸丙酚替诺福韦(TAF)与富马酸替诺福韦二吡呋酯(TDF)治疗慢性乙型肝炎(CHB)患者的效果差异。方法 2022年1月～2024年1月我中心诊治的CHB患者202例,被随机分为两组,每组101例,分别给予TAF和TDF治疗,观察12个月。采用ELISA法检测血清HBeAg、HBsAg、透明质酸(HA)、IV胶原蛋白(IV-C)、III型前胶原肽(PC-III)和层粘连蛋白(LN),采用实时荧光定量PCR法检测血清HBV DNA载量,使用双能X线骨密度仪检测骨密度,采用慢性肾脏病流行病合作工作组(CKD-EPI)发布的公式计算肾小球滤过率。结果在治疗12个月末,两组血清HBV DNA均转阴,血清AST和ALT水平恢复正常;两组血清HA、IV-C、PC-III和LN水平变化无显著性差异(P>0.05);TAF治疗组骨密度和肾小球滤过率降低发生率为2.0%,显著低于TDF治疗组的10.9% (P<0.05)。结论应用TAF或TDF治疗CHB患者均有良好的效果,近期疗效相当,但治疗对骨密度和肾功能的影响还需要长期观察。

关键词: 慢性乙型肝炎, 丙酚替诺福韦, 替诺福韦二吡呋酯, 骨密度, 肾功能, 治疗

Abstract: Objective The aim of this study was to observe antiviral efficacy and impacts on bone mineral density and renal functions of tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) in the treatment of patients with chronic hepatitis B (CHB). Methods A total of 202 patients with CHB were enrolled in our health management center between January 2022 and January 2024, and were randomly assigned to receive oral TAF in 101 cases or TDF in another 101 cases. Observation lasted for 12 months. Serum HBeAg, HBsAg, and hyaluronic acid (HA), IV collagen (IV-C), type III procollagen peptide (PC-III) and laminin (LN) levels were detected by ELISA. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR. Bone mineral density was determined by dual-energy X-ray absorptiometry scanner, and glomerular filtration rate (GFR) was calculated based on CKD-EPI formula. Results By the end of 12 months of treatment, serum HBV DNA turned to undetectable, and serum AST and ALT levels normalized in the two groups; there were no significant differences as respect to serum HA, IV-C, PC-III and LN levels in the two groups (P>0.05); incidence of decreased bone mineral density and GFR in TAF-treated patients was 2.0%, much lower than 10.9% (P<0.05) in TDF-treated patients. Conclusion The antiviral efficacy of TAF and TDF is parallel in the treatment of patients with CHB, and their impact on bone mineral density and GFR needs long-term clinical observation.

Key words: Hepatitis B, Tenofovir alafenamide fumarate, Tenofovir disoproxil fumarate, Bone mineral density, Glomerular filtration rate, Therapy

高原, 张爱兰, 林丽泉, 程小桂. 应用富马酸丙酚替诺福韦和富马酸替诺福韦二吡呋酯治疗慢性乙型肝炎患者疗效分析^*[J]. 实用肝脏病杂志, 2026, 29(5): 661-664.

Gao Yuan, Zhang Ailan, Lin Liqian, et al. Antiviral efficacy and impacts on bone mineral density and renal functions of tenofovir alafenamide fumarate and tenofovir disoproxil fumarate in the treatment of patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2026, 29(5): 661-664.

参考文献

[1] Thuy D T, Ha T N,Cuong D D, et al. Cost-effectiveness of tenofovir alafenamide fumarate for treatment of chronic hepatitis B: Evidence from a tertiary hospital in Vietnam. Antivir Ther,2025,30(3):13596535251349054.
[2] Zeng H Z,Liu Q J,Zhang M, et al. Tenofovir amibufenamide in chronic hepatitis B: Lipid changes and 144-week safety with tenofovir disoproxil fumarate-to-tenofovir amibufenamide switch. World J Gastroenterol,2025,31(26):109285.
[3] 王文鑫,郭玉明,费竹轩,等.小分子核酸药物治疗慢性乙型肝炎的临床研究进展.中华肝脏病杂志,2025,33(12):1199-1206.
[4] Kim Y L,Kim Y J,Yoo J J, et al. Tenofovir disoproxil fumarate versus entecavir: effects on lipid profiles and cardiovascular outcomes in people living with chronic hepatitis B. J Med Virol,2025,97(2):e70187.
[5] Chenxia Z,Xinyue C,Zehua H, et al. Comparison of efficacy and safety of entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide fumarate treatment in patients with high viral load of hepatitis B virus. Medicine,2025,104(35):e43946-e43946.
[6] 熊霞鹂,周鑫,朱云霞,等. 富马酸丙酚替诺福韦与替诺福韦二吡呋酯阻断HBV母婴传播有效性和安全性研究. 实用肝脏病杂志,2025,28(2):182-185.
[7] Li S,Jiang Y,Shi J, et al. Impact of stopping Tenofovir disoproxil fumarate at various times on elevated postpartum ALT levels and breastfeeding in pregnant women with chronic hepatitis B: a prospective observational cohort study. BMC Pregnancy Childbirth,2025,25(1):900-900.
[8] 中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版). 中华肝脏病杂志,2022,30(12):1309-1331.
[9] 刘智泓,金清龙,张跃新,等. 延长或转换至艾米替诺福韦治疗慢性乙型肝炎患者的安全性:一项Ⅲ期、多中心、随机对照研究. 中华肝脏病杂志,2024,32(10):893-903.
[10] Shi Y,Xie Y,Chen Y, et al. Epidemiological and clinical impact of hepatitis E virus coinfection in chronic hepatitis B infected patients in Hebei, China. Frontiers Microbiol,2025,16(2):1638614-1638614.
[11] Ko Y,Song G B,Shin H, et al. Correction: Comparison of bone mineral density changes between denosumab and bisphosphonates in tenofovir-exposed chronic hepatitis B patients with osteoporosis. Osteoporos Int,2025,(prepublish):1.
[12] 符鑫,刘悦,彭鑫,等. 采用高敏检测技术检测血清HBV DNA载量筛选低病毒血症的无偿献血人群隐匿性乙型肝炎病毒感染研究. 实用肝脏病杂志,2023,26(2):169-172.
[13] Ha H,Seo I K,Je K N. Factors associated with TDF-to-TAF switching in chronic hepatitis B: a nationwide cohort study in South Korea. J Infect Chemother,2025,31(12):102860.
[14] 刘丽霞,林应源,李华敏,等. 劳拉西泮与奥沙西泮治疗酒精性肝病并发酒精戒断综合征患者临床疗效比较研究. 实用肝脏病杂志,2021,24(5):709-712.
[15] Li X,Yin Q,Zhao G, et al. Prognostic value of albumin and aspartate aminotransferase/alanine aminotransferase ratio in patients with acute liver failure in hyperacute phase of sepsis: a multicenter retrospective cohort study. Chin Crit Care Med,2024,36(11):1121-1126.
[16] 罗良德,任成果,王守军,等. 恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究. 实用肝脏病杂志,2024,27(3):333-336.
[17] Tseng H C,Lee Y T,Chen Y C, et al.Incidences of virological and clinical relapses after cessation of tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir in patients with hbeag-negative chronic hepatitisB. J Gastroenterol Hepatol,2025,40(5):1245-1254.
[18] 王玉珊,孔银,刘元元,等. 不同转换治疗策略对经治的低病毒血症慢性乙型肝炎患者疗效的影响:单中心回顾性研究. 实用肝脏病杂志,2022,25(5):633-636.
[19] Liu Y,Wang L,Li L, et al. Letter on "efficacy and safety of tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) followed by TAF in chronic hepatitis B patients of east Asian ethnicity following 5 years of treatment". Aliment Pharmacol Ther,2025,63(1):173-174.
[20] Yang J,Lim J,Kim J Y, et al. Hepatocellular carcinoma risk in chronic hepatitis B patients treated with tenofovir alafenamide or tenofovir disoproxil fumarate. Liver Int,2025,45(10):e70357-e70357.
[21] Tseng H C,Lee Y T,Chen Y C, et al. Incidences of virological and clinical relapses after cessation of tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir in patients with HBeAg-negative chronic hepatitis B. J Gastroenterol Hepatol,2025,40(5):1245-1254.

应用富马酸丙酚替诺福韦和富马酸替诺福韦二吡呋酯治疗慢性乙型肝炎患者疗效分析^*

Antiviral efficacy and impacts on bone mineral density and renal functions of tenofovir alafenamide fumarate and tenofovir disoproxil fumarate in the treatment of patients with chronic hepatitis B

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	祁雁, 杜合娟, 张晨霞, 史帝文, 邱源旺. 聚乙二醇干扰素α-2b联合核苷(酸)类似物治疗慢性乙型肝炎患者血清HBsAg清除率及其影响因素分析^*[J]. 实用肝脏病杂志, 2026, 29(5): 665-668.
[2]	李甜甜, 吴岩. GLP-1受体激动剂治疗2型糖尿病合并非酒精性脂肪性肝炎患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 673-676.
[3]	刘德军, 刘婧, 袁翊. 自身免疫性肝炎患者血清AAPR、LECT2和IL-21水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2026, 29(5): 677-680.
[4]	赵先群, 闫斌斌, 李德洋, 田春阳, 张向东. 原发性胆汁性胆管炎患者临床特征、自身抗体特点和预后分析^*[J]. 实用肝脏病杂志, 2026, 29(5): 685-688.
[5]	陈丽虹, 刘银辉, 高梅芳, 李品娣, 吴伟新, 张玮, 李洪昌. 肝病专用型肠内营养制剂治疗失代偿期乙型肝炎肝硬化患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 705-708.
[6]	茹秀峰, 秦琳, 董小平, 李振平, 何锦来, 胡永辉. 脾动脉高选择性插管部分脾栓塞术治疗肝炎肝硬化并发脾功能亢进症患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 713-716.
[7]	冯丹丹, 刘子涵, 郝苗, 苟国娥, 党双锁. TACE联合仑伐替尼和卡瑞利珠单抗治疗中晚期原发性肝癌患者临床疗效和安全性研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 721-724.
[8]	朱贺, 李瑶姬, 王锐, 沈志纲. 信迪利单抗联合仑伐替尼治疗中晚期原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 729-732.
[9]	张莉, 杨均铖, 王佳, 杨国栋, 毛欢, 罗云蔓. 增强CT扫描评估TACE术治疗原发性肝癌患者效果研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 733-736.
[10]	吴红, 沈兰超, 姜正伟, 吕春, 蒋培莉. C-TACE与D-TACE治疗原发性肝癌患者疗效与安全性比较研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 737-740.
[11]	梁蓁, 李瑶, 王莹. 超声引导下三种不同微创方法治疗单纯性肝囊肿患者疗效比较研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 749-752.
[12]	刘燕, 周祥, 钟玲. 超声引导下经皮穿刺置管引流治疗化脓性肝脓肿患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 753-756.
[13]	祝平, 朱佳, 李晓飞, 魏源, 卢西雅. 内镜下鼻胆管引流联合ERCP/EST治疗胆总管结石合并中重度急性胆管炎患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 773-776.
[14]	韩博强, 杨林, 张成, 周党军, 赵宝国, 李文翰. 急性梗阻性化脓性胆管炎患者病原菌分布及ERCP治疗疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 777-780.
[15]	李文静, 汪奕慧, 马韩婷, 孙杰. 内镜逆行胰胆管造影和经皮肝穿刺胆道引流姑息性治疗肝门部胆管癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 789-792.