恩替卡韦联合微生态制剂治疗乙肝肝硬化患者的临床疗效研究

Clinical effect of entecavir combined with probiotics on treatment of patients with hepatitis B cirrhosis

目的:观察恩替卡韦联合双歧三联活菌胶囊治疗乙型病毒性肝炎致肝硬化患者的临床应用效果。方法:将2014年7月至2017年1月于宁波市第二医院肝病科收治的乙型肝炎病毒感染致肝硬化患者160例,按照随机数字表法分成对照组以及观察组,各80例。两组均予保肝基础治疗及恩替卡韦0.5 mg/次/d口服抗病毒治疗,观察组在此基础上加用双歧三联活菌胶囊一日2次,2~4粒/次。两组均持续治疗6个月,期间观察两组患者的临床表现、肝脏B超及肝功能、肝纤维4项、内毒素、外周血T细胞亚群水平。结果:观察组及对照组治疗前后,丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、血氨及内毒素、肝纤维化及免疫反应指标、门静脉内径及脾脏厚度均有显著改善,差异有统计学意义(P<0.05),而且观察组指标的改善情况优于对照组,差异有统计学意义(P<0.05),但两组并发症发生情况比较差异无统计学意义。结论:恩替卡韦联合双歧三联活菌胶囊治疗能改善乙肝肝硬化患者肠道稳态,有效改善肝脏功能,减缓肝脏纤维化,临床效果显著。

AIM：To observe the clinical efficacy of nucleoside antiviral drugs（entecavir） combined with probiotics（Bifid triple viable capsules）in the treatment of patients with hepatitis B cirrhosis.METHODS：One hundred and sixty patients with cirrhosis caused by hepatitis B virus infection admitted to our department of hepatology from July2014 to January 2017 were randomly divided into control group and observation group,with 80 cases in each group.The two groups were treated with basic liver protection,and the control group was treated with entecavir 0.5 mg/times/day orally,while the observation group was given extra Bifidobacterium triple viable capsules 2 times a day,2-4 capsules per time.All patients received continuous treatment for 6 months,during which the clinical signs,the liver region B ultrasound,liver function,the liver fiber 4 items and the peripheral blood T cell subgroup level of two groups were observed.RESULTS：Compared with before treatment,ALT,AST,TBIL,blood ammonia and endotoxin,liver fibrosis and immune response index,the diameter of portal vein and spleen thickness were significantly improved after treatment（P〈0.05）;also,compared with control group,those indexes of the observation group improved more significantly（P〈0.05）;comparison of the complications after treatment had no significant difference.CONCLUSION：Entecavir combined with Bifidobacterium triple viable capsule can improve the intestinal homeostasis,further reduce liver fibrosis and improve liver function in patients with viral hepatitis B cirrhosis.