恩替卡韦对慢性乙型病毒性肝炎蜘蛛痣、性激素及病毒水平的影响——附27例报告

Effect of entecavir on spider nevi,sex hormone and HBV DNA level in patients with chronic hepatitis B

目的:观察恩替卡韦对慢性乙型病毒性肝炎(CHB)患者蜘蛛痣、性激素及病毒水平的影响。方法:54例HBeAg阳性的CHB患者分为观察组及对照组各27例,分别给予恩替卡韦及拉米夫定治疗6个月,比较两组治疗前后的蜘蛛痣数量及直径、性激素水平、病毒学及肝功能的变化。结果:治疗前两组患者的蜘蛛痣数量、直径、性激素水平、病毒学及肝功能指标比较差异均无统计学意义(P均>0.05),蜘蛛痣部位以胸前为主。与对照组比较,观察组治疗后的蜘蛛痣数量更少、直径更短,血浆睾酮水平更高、雌二醇水平更低,HBV DNA及HBsAg水平更低,肝功能好转更为明显(P<0.05或0.01)。Pearson参数法分析表明,HBV DNA水平与蜘蛛痣的数量、直径均呈正相关(r分别为0.952、0.945,P均<0.01);蜘蛛痣的数量与直径呈正相关(r=0.951,P<0.01)。结论:蜘蛛痣与HBV DNA水平密切相关;恩替卡韦干预对CHB患者蜘蛛痣、性激素、病毒学及肝功能的疗效优于拉米夫定。

Objective： To explore the effect of entecavir（ETV） on spider nevi（SN）,sex hormone and HBV-DNA level in patients with chronic hepatitis B（CHB）.Methods： Fifty-four HBeAg-positive CHB patients were divided into the observation and control group（both n=27）,the former of which were given ETV while the latter were given lamivudine（LAM）.All patients were treated for six-months.The amount and diameter of SN,level of sex hormone,quantities of HBV-DNA and HBsAg together with liver function were compared before and after treatment.Results： There was no significant difference of amount and diameter of SN between the two groups before treatment,and the SN were mainly found in bosom.Compared with the control group,less and smaller SN were found in the observation group（P0.05 and P0.01,respectively）.Furthermore,higher level of plasma testosterone as well as lower level of estradiol,HBV DNA,HBsAg and better liver function were all found in the observation group when compared to the control group（all P0.05）.Pearson correlation analysis showed that the log of HBV-DNA correlated positively with both the amount and diameter of SN（all r0.09 and P0.01）.Conclusion： The amount and diameter of SN were significantly related to HBV-DNA.Compared with LAM,ETV was more effective on regulating the development of spider nevi,level of sex hormone and HBV-DNA level in patients with CHB.