恩替卡韦治疗失代偿期乙型肝炎肝硬化临床观察

Therapeutic effects of entecavir on the decompensated cirrhosis caused by HBV

目的观察恩替卡韦(ETV)治疗失代偿期乙型肝炎肝硬化的疗效。方法 68例失代偿期乙型肝炎肝硬化患者随机分成2组:对照组32例采用常规保肝对症治疗,治疗组36例在常规治疗基础上给予口服ETV 0.5 mg/d,2组疗程均为52周。以治疗12,24,52周的病毒学、血清学、肝功能、凝血酶原活动度(PTA)、肝纤维化指标、Child-Pugh积分作为观察指标。结果治疗组HBV DNA拷贝数下降值、阴转率显著高于对照组,有显著性差异(P均<0.01)。在24和52周治疗组患者血清HBeAg阴转率及HBeAg/抗-HBe血清学转换率与对照组比较有显著性差异(p均<0.01)。治疗组在24周时肝功能、PTA好转及Child-Pugh积分下降,2组比较有显著性差异(P均<0.05);在52周时肝纤维化指标均显著改善,且2组比较有显著性差异(P均<0.05)。结论 ETV能快速、有效抑制HBV病毒复制,改善失代偿期乙型肝炎肝硬化患者的肝功能、PTA、肝纤维化指标及Child-Pugh积分等。

Objective It is to observe the therapeutic effects of entecavir on decompensated cirrhosis caused by HBV. Methods Sixty-eight patients with liver cirrhosis caused by HBV were randomly divided into two groups：treatment group （n = 36） and control group（ n = 32）. The control group received the conventional liver protecting treatment. Besides the protecting treatment, the treatment group received the treatment of entecavir（0.5 mg/d）. Both the treatment courses lasted for fifty-two weeks. In 12, 24, 52 weeks after treatment, the virological copies, biochemical parameters, PTA, hepatic fibrosis index and Child - Pugh scores were observed. Results The copies of HBV - DNA in treatment group were significantly decreased than that of the control group. The negative ratio of HBV - DNA （ 〈 100 copies/ml） in treatment group was significantly higher than that in control group （P 〈 0.05 ）. After 24 and 52 weeks＇ treatments, the negative ratios of HBeAg and the ratios of HBeAg/ anti-HBe sero-conversion in treatment group were significantly higher than those in control group （P 〈 0. 05）. ALT, AST, TBil, hepatic fibrosis index and Child - Pugh scores were significantly improved in treatment group at 24week time-point （P 〈 0.05）. After 52 week＇s treatment, the indexes of hepatic fibrosis were all improved in both groups, and compared with each other, the differences were significant （ P 〈 0.05 ）. Conclusion Entecavir can rapidly and effectively inhibit the replication of HBV - DNA and improve hepatic function,hepatic fibrosis index and Child -Pugh scores in patients with liver cirrhosis at de- compensated stage caused by HBV.