超声介入法治疗代偿期乙型肝炎肝硬化109例疗效分析

Improvement of hepatic histological changes in patients with compensated hepatitis B-induced liver cirrhosis receiving interventional ultrasound treatment

目的探讨超声介入法治疗代偿期乙型肝炎肝硬化患者的疗效。方法收集本科收治的代偿期乙型肝炎肝硬化患者181例,其中治疗组109例,对照组72例。给予对照组核苷类抗病毒药物联合甘草酸二铵、促肝细胞生长素等治疗,给予治疗组核苷类药物联合超声介入治疗。观察治疗后1年、2年、3年肝功能、凝血功能、血常规、HBV DNA、腹部超声检查指标的变化。两组患者均在超声定位引导下进行肝组织活检,比较治疗前及治疗3年后肝组织病理学改善率及肝组织活动指数(HAI)和肝纤维化指数(HFI)的变化。结果两组患者基线情况及治疗后HBV DNA阴转率无明显差异。治疗组在治疗3年时血白蛋白为(40.9±4.1)g/L,显著高于对照组[(38.7±3.4)g/L,P<0.05],凝血酶原活动度为(69.7±11.4)%,显著高于对照组[(65.9±9.4)%,P<0.05];治疗组在3年时门静脉内径和脾长分别为(1.18±0.14)cm和(11.74±1.18)cm,显著低于对照组[(1.24±0.14)cm和(12.78±1.43)cm,P<0.05];3年后治疗组肝组织病理学改善率为54.1%,显著高于对照组的25.0%(P<0.01);3年时治疗组HAI和HFI分别为(3.64±0.86)和(3.87±0.84),显著低于对照组[(8.94±1.42)和(6.83±1.12),P<0.05]。结论超声介入治疗可有效改善代偿期乙型肝炎肝硬化患者的肝功能,减轻门脉高压症,减轻肝纤维化程度,肝组织病理学改善率明显提高。

Obiective To investigate the efficacy of ultrasound interventional therapy for patients with com- pensated liver cirrhosis due to hepatitis B infection. Methods 181 patients with compensated liver cirrhosis were enrolled in this study,including 109 cases in the treatment group,and 72 cases in the control group. The patients in the control group were given nucleoside analogues,and in the treatment group were given interventional ultra- sound treatment at the base of antiviral therapy. All patients were followed-up by ultrasound-guided liver biopsy for histological activity index and hepatic fibrosis index,and liver function,blood routine and abdominal ultrasound cheek-up after 1 years,2 years,and 3 years of treatment. Result There was no significant difference of serum HBV DNA loss rates between the two groups;The serum albumin level in patients of treatment group at the end of 3 years was （40.9±4.1） g/L,significantly higher than in the control group [（38.7±3.4） g/L,P〈0.05],prothrombin time activity were（69.7±1l.4） %,significantly higher than that in the control group E（65.9±9.4） %,P〈0.05]. The diameter of portal vein and splenic length were （1.18±0.14） cm and （11.74±1.18） cm,significantly lower than those in the control group [（1.24±0.14） cm and （12.78±1.43） cm,P〈0.05]. The histopathologieal improvement rate in treatment group was 54.1%,significantly higher than 25.0% in the control group （P〈0.01）. The HAl and HFI were （3.64±0.86） and （3.87±0.84）,were both significantly lower than in the control group [（8.94±1.42） and （6.83±1.12）,respectively,P〈0.05]. Conclusion The treatment in our series can effectively improve the liver function of patients with compensated liver cirrhosis ,reducing portal hypertension and improving liver fibrosis.