摘要
目的 探讨熊去氧胆酸联合阿德福韦酯治疗乙型肝炎肝硬化的临床效果.方法 选取2010年10月至2014年12月在武汉大学人民医院感染性疾病科及黄石市中心医院感染性疾病科经肝穿刺活检以及血清检查确诊的失代偿期乙型肝炎肝硬化患者65例,采用随机数字表法分为观察组(33例)和对照组(32例),观察组患者口服阿德福韦酯胶囊(10 mg/d,1次/d)和熊去氧胆酸胶囊(250 mg/片,2次/d)治疗,对照组单纯口服阿德福韦酯胶囊(10 mg/d,1次/d)治疗.2组基本疗程为48周.比较2组治疗前及治疗12、24、48周后的乙型肝炎病毒(HBV) DNA含量、血清丙氨酸转氨酶(ALT)、总胆红素、γ谷氨酰转肽酶(γ-GT)、碱性磷酸酶(ALP)、血清球蛋白(GLO)水平及慢性肝病问卷得分情况(包括腹部症状、困乏、全身症状、活动能力、情感功能、焦虑),和治疗12、24、48周后的乙型肝炎e抗原(HBeAg)转阴率、HBV DNA转阴率及腹腔积液消失情况.结果 2组治疗前HBV DNA含量比较,差异无统计学意义(P>0.05).治疗12、24A8周后,观察组HBV DNA含量均明显低于对照组同时点[(3.5±0.9)lg拷贝/ml比(4.3±1.2)lg拷贝/ml、(3.3±0.7)lg拷贝/ml比(3.9±0.9)lg拷贝/ml、(3.0±0.5)lg拷贝/ml比(3.3±0.9)lg拷贝/ml],差异有统计学意义(P<0.05).观察组治疗12、24、48周后的HBeAg转阴率和HBV DNA转阴率均高于对照组[21.2%(7/33)比12.5% (4/32)、33.3%(11/33)比25.0%(8/32)、45.5%(15/33)比34.4% (11/32);36.4%(12/33)比25.0%(8/32)、57.6%(19/33)比40.6% (13/32)、78.8%(26/33)比62.5% (20/32)],差异有统计学意义(P<0.05).2组治疗前ALT、总胆红素、γ-GT、ALP、GLO水平比较,差异无统计学意义(P>0.05).观察组治疗12、24、48周后ALT、总胆红素、γ-GT、ALP、GLO水平明显低于对照组同时点[(29 ±9)U/L比(34±12) U/L、(20 ±6)U/L比(30 ±8) U/L、(14 ±5)U/L比(22±7) U/L;(17 ±6) μmol/L比(30±8)μmol/L、(15±4) μmol/L比(23±6)μmol/L、(15 ±4) μmol/L比(20 ±6) μmol/L;(41±10)U/L比(65±13) U/L、(30 ±9) U/L比(54±11) U/L、(17 ±6) U/L比(26±8)U/L;(36 ±9) U/L比(60±12) U/L、(25±8)U/L比(37±10) U/L、(19±7)U/L比(27±9)U/L;(8.8±1.8)g/L比(15.5±2.1)g/L、(4.5±1.1)g/L比(10.5±1.9)g/L、(2.6±0.7)g/L比(7.8±1.4)g/L],差异有统计学意义(P<0.05).观察组治疗12、24 、48周后的腹腔积液消失率均明显高于对照组[30.3% (10/33)比15.6%(5/32)、45.5%(15/33)比25.0%(8/32)、75.8%(25/33)比53.1%(17/32)],差异有统计学意义(P<0.05).2组治疗前慢性肝病问卷各项指标得分比较,差异无统计学意义(P>0.05).观察组治疗24、48周后和对照组治疗48周后腹部症状、困乏、全身症状、活动能力、情感功能、焦虑得分均明显低于治疗前[观察组:(3.9±1.2)、(3.3±0.9)分比(4.8±1.5)分,(3.7±1.0)、(3.0±0.8)分比(4.3±1.3)分,(4.7±0.9)、(2.8±0.7)分比(5.7±1.0)分,(4.0±1.0)、(3.1±0.9)分比(4.7±1.3)分,(4.2±1.3)、(3.3±1.0)分比(4.7±1.6)分,(4.0±1.3)、(3.2±0.9)分比(4.3±1.6)分;对照组:(3.9±1.1)分比(4.4±1.5)分,(3.8±1.1)分比(4.2±1.3)分,(4.6±0.8)分比(5.7±0.9)分,(4.1±1.0)分比(4.4±1.3)分,(4.0±1.5)分比(4.5±1.8)分,(3.9±1.2)分比(4.4±1.5)分],治疗48周后,观察组各项指标得分明显低于对照组,差异均有统计学意义(均P<0.05).结论 熊去氧胆酸联合阿德福韦酯能够有效抑制乙型肝炎肝硬化患者体内的HBV DNA含量,提高患者HBeAg转阴率,改善患者肝功能情况和生活质量。
Objective To investgate the effect of ursodeoxycholi acid combined with adefovir dipivoxil in treating hepatitis B cirrhosis.Methods Sixty-five patients with hepatitis B cirrhosis in decompensated stage confirmed by needle biopsy and serological test from October 2012 to December 2014 were randomly divided into observation group (33 cases) given oral administration of adefovir dipivoxil (10 mg/d, 1 time/d) and ursodeoxycholi acid (250 mg/d, 2 times/d), and control group (32 cases) given adefovir dipivoxil (10 mg/d, 1 time/d);both groups were treated with comprehensive treatment and the treatment was lasted for 48 weeks.Before and 12, 24, 48 weeks after treatment, the hepatitis B virus (HBV) DNA level, alanine aminotransferase (ALT) , total bilirubin (TBIL),γ-glutamyl-transferase (γ-GT), alkaline phosphatase (ALP), globulin (GLO) were measured;the score of chronic liver disease questionnaire (CLDQ) (including abdominal symptoms, fatigue, systemic symptoms, activity ability, emotional function, anxious) were assessed;the negative conversion rates of HBV e antigen (HBeAg) and HBV DNA, the disappearance rate of ascites were observed.Results The HBV DNA level had no significant difference between groups before treatment (P 〉 0.05).The HBV DNA levels in observation group 12,24 and 48 weeks after treatment were significantly lower than those in control group [(3.5 ± 0.9) lg copies/ml vs (4.3 ± 1.2) lg copies/ml, (3.3 ± 0.7) lg copies/ml vs (3.9 ± 0.9) lg copies/ml, (3.0 ± 0.5) lg copies/ml vs (3.3 ± 0.9) lg copies/ml] (P 〈 0.05).The negative conversion rates of HBeAg and HBV DNA in observation group 12, 24 and 48 weeks after treatment were significantly higher than those in control group [HBeAg: 21.2% (7/33) vs12.5% (4/32), 33.3% (11/33)vs25.0% (8/32),45.5% (15/33)vs34.4% (11/32);HBV DNA : 36.4% (12/33) vs 25.0% (8/32), 57.6% (19/33) vs 40.6% (13/32), 78.8% (26/33) vs 62.5% (20/32)] (P 〈 0.05).The levels of ALT, TBIL, γ-GT, ALP, GLO had no significant differences between groups before treatment (P 〉 0.05);they were significantly lower in observation group than those in control group after 12, 24 and 48 weeks after treatment [ALT: (29 ±9) U/L vs (34 ± 12) U/L, (20 ±6) U/L vs (30 ± 8) U/L, (14 ±5) U/L vs (22 ±7) U/L;TBIL: (17 ±6) μmol/L vs (30 ±8) μmol/L, (15 ±4) μmol/L vs (23 ±6) μmol/L, (15 ±4) μmol/L vs (20 ±6) μmol/L;γ-GT: (41 ± 10) U/L vs (65 ± 13) U/L, (30 ± 9) U/Lvs (54±11) U/L, (17±6) U/Lvs (26±8) U/L;ALP: (36±9) U/Lvs (60±12) U/L, (25±8) U/Lvs (37±10) U/L, (19±7) U/Lvs (27±9) U/L;GLO: (8.8±1.8) g/Lvs (15.5±2.1) g/L,(4.5 ± 1.1) g/L vs (10.5 ± 1.9) g/L, (2.6 ± 0.7) g/L vs (7.8 ± 1.4) g/L] (P 〈 0.05).The disappearance rate of ascites in observation group was significantly higher than that in control group 12, 24 and 48 weeks after treatment [30.3% (10/33)vs 15.6% (5/32), 45.5% (15/33)vs 25.0% (8/32), 75.8% (25/33)vs 53.1% (17/32)] (P 〈 0.05).The scores of CLDQ before treatment had no significant differences between groups (P 〉 0.05);the scores of abdominal symptoms, fatigue, systemic symptoms, activity ability, emotional function, anxious 24 and 48 weeks after treatment were all significantly improved than those before treatment in observation [(3.9±1.2), (3.3±0.9) scores vs (4.8±1.5) scores;(3.7±1.0), (3.0±0.8) scores vs (4.3±1.3) scores;(4.7 ±0.9), (2.8 ±0.7) scores vs (5.7 ± 1.0) scores;(4.0± 1.0), (3.1 ± 0.9) scores vs (4.7 ± 1.3) scores;(4.2 ± 1.3) , (3.3 ± 1.0) scores vs (4.7 ± 1.6) scores;(4.0 ± 1.3) , (3.2±0.9) scores vs (4.3±1.6) scores] and control group [(3.9 ±1.1) scores vs (4.4±1.5) scores;(3.8±1.1) scoresvs (4.2±1.3) scores;(4.6±0.8) scores vs (5.7±0.9) scores;(4.1±1.0) scoresvs (4.4 ± 1.3) scores;(4.0 ± 1.5) scores vs (4.5 ± 1.8) scores;(3.9 ± 1.2) scores vs (4.4 ± 1.5) scores] (P 〈 0.05);they were significantly lower in observation group than those in control group 48 weeks after treatment (P 〈 0.05).Conclusion Ursodeoxycholi acid combined with adefovir dipivoxil can effectively inhibit the HBV DNA level, increase the negative converse rate of HBeAg and improve the life quality in patients with hepatitis B cirrhosis.
出处
《中国医药》
2015年第11期1618-1622,共5页
China Medicine
关键词
肝炎
乙型
肝硬化
熊去氧胆酸
阿德福韦酯
生活质量
Hepatitis,type B
Liver cirrhosis
Ursodeoxycholi acid
Adefovir dipivoxil
Quality of life