恩替卡韦联合保肝药物治疗肝硬化失代偿期患者的疗效分析

Therapeutic effects of entecavir combined with hepatoprotective therapy in patients with end-stage cirrhosis

目的观察口服恩替卡韦联合保肝药物对乙型肝炎(简称乙肝)肝硬化失代偿期患者的疗效。方法选取2009年1月至2012年1月本院收治的120例乙肝肝硬化失代偿期患者,随机分为两组,各60例;对照组采用单纯保肝药物治疗,治疗组采用保肝药物联合恩替卡韦(0.5mg/d)治疗,疗程96周;比较两组患者肝功能,补体C3、C4水平,HBV-DNA含量,并观察不良反应的发生情况。结果治疗96周后,两组血清丙氨酸基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及总胆红素(TB)水平均明显降低,且治疗组均明显低于对照组,差异均有统计学意义(P<0.05);两组补体C3、C4水平明显高于治疗前,且治疗组明显高于对照组,差异均有统计学意义(P<0.05);治疗组生存率(79.0%)明显高于对照组(43.0%),差异有统计学意义(P<0.05);两组不良反应发生情况比较差异无统计学意义(P>0.05)。结论采用口服恩替卡韦联合保肝药物治疗乙肝终末期肝硬化,能够减少肝脏损害,保护肝脏免疫功能,提高生存率,同时不增加不良反应的发生率。

Objective To observe the therapeutic effects of oral application of entecavir combined with hepato‐protective drugs in patients with end‐stage cirrhosis after hepatitis B .Methods A total of 120 patients with end‐stage cirrhosis after hepatitis B ,treated in this hospital during Jan .2009 and Jan .2012 ,were randomly divided into two groups .The control group （n=60） was treated with hepatoprotective drugs ,while the treatment group （n=60） was treated with entecavir （0 .5 mg/d） combined with hepatoprotective drugs .After 96 weeks of treatment ,levels of liver function ,C3 ,C4 ,hepatitis B virus （HBV）‐DNA and the adverse reactions were compared between the two groups . Results After 96 weeks of treatment ,the serum levels of alanine aminotransferase （ALT ） ,aspartate aminotrans‐ferase （AST ） and total bilirubin （TB） of the two groups decreased significantly ,and the levels of treatment group were significantly lower than control group （P〈0 .05） .Complement C3 and C4 levels in the two groups were signifi‐cantly increased after treatment ,and the levels of treatment group were significantly higher than control group （P〈0 .05） .After treatment ,the survival rate of treatment group was 79 .0% ,higher than the 43 .0% of control group （P〈0 .05） .There was no statistically significant differences of the incidence of adverse reactions between the two groups （P〈0 .05） .Conclusion Hepatoprotective therapy combined with entecavir could reduce liver damage ,protect liver immune function and improve survival rate of patients with end‐stage cirrhosis after hepatitis B ,without increas‐ing of adverse reaction incidence .