恩替卡韦抗病毒治疗对肝性糖尿病患者血糖控制及肝功能的影响研究

Randomized Controlled Study of Entecavir Antiviral Therapy to Improve Hepatic Diabetes

目的观察恩替卡韦抗病毒治疗对肝性糖尿病患者血糖控制及肝功能的影响。方法选择我院2008年1月—2011年5月收治的肝性糖尿病患者42例,根据是否应用恩替卡韦分为治疗组和对照组,每组21例。两组患者均给予诺和灵30R胰岛素注射液,参考说明书剂量进行个体化治疗。治疗组在此基础上加用恩替卡韦分散片0.5 mg口服,1次/d;对照组给予多烯磷脂酰胆碱胶囊口服,2粒/次,3次/d。两组均连续治疗12周,记录治疗4周、8周及12周后患者血糖达标率。采用高压液相色谱法检测两组患者治疗前后血糖指标,全自动生化分析仪检测两组治疗前后肝功能指标,ELLSA法测定乙肝病毒标志物,聚合酶链式反应(PCR)荧光定量法检测乙型肝炎病毒载量(HBV-DNA)。结果两组治疗前血糖指标、胰岛素抵抗指数(HOMA-IR)、肝功能指标及HBV-DNA比较,差异均无统计学意义(P>0.05)。治疗后两组餐后2 h血糖、空腹胰岛素、HOMA-IR、肝功能指标及HBV-DNA比较,差异均有统计学意义(P<0.05)。对照组4周、8周及12周血糖达标率分别为7/21、12/21及15/21,治疗组分别为14/21、18/21及21/21;两组4周、8周及12周血糖达标率比较,差异均有统计学意义(χ2值分别为4.67、4.20及4.86,P<0.05)。结论在胰岛素治疗基础上恩替卡韦抗病毒治疗可改善肝性糖尿病患者肝功能,降低HBV-DNA,进而改善其胰岛素抵抗;缩短血糖达标时间,提高血糖达标率,可使肝性糖尿病患者血糖快降至正常水平,有助于血糖控制。但恩替卡韦抗病毒治疗对肝性糖尿病患者的长期疗效及患者耐受性有待进一步观察研究。

s] Objective To observe the effect of entecavir antiviral therapy on blood glucose control and liver function in patients with hepatic diabetes （HD）. Methods Forty -two HD patients admitted from January 2008 to May 2011 were divided into groups treatment and control, 21 in each. Both groups were given novolin 30R insulin injection and individualized treatment based on the reference doses of The Specifications. Treatment group received additional entecavir dispersible tablets, 0. 5 mg, orally, once/d ; control group given polyene phosphatidylcholine capsule, orally, 2/time, 3 times/d The treatment lasted 12 weeks. The ratios of reaching glucose standard were recorded in weeks 4, 8, 12 after treatment. Glycemic indexes were measured by high pressure liquid chromatography before and after treatment, liver indexes by automatic biochemical analy- zer, hepatitis B virus markers （HBV -DNA） by PCR fluorescence quantitative assay. Results No significant difference was noted in glycemic index, HOMA - IR, liver function and HBV - DNA between 2 groups before treatment （ P 〉 0. 05 ） , but there was in postprandial 2 h glucose, fasting insulin and insulin resistance index, liver function and HBV - DNA （P 〈 0. 05 ）. In control group, the ratios of reaching glucose standard in weeks 4, 8, 12 were 7/21, 12/21, 15/21, respectively; in treatment group, 14/21, 18/21, 21/21, respectively; the difference was significant （ X2 = 4. 67, 4. 20, 4. 86, respectively, P 〈 0.05 ）. Conclusion Entecavir antiviral therapy based on insulin treatment, which can improve liver function, reduce hepatitis B virus load, thus to improve its insulin resistance, shorten time of reaching standard, make blood glucose decrease rapidly to normal, contribute to blood glucose control. But its long -term efficacy arid tolerability needs further observation and study.