药物干预慢性HBV感染肝组织纤维化的随访观察

Follow-up observation of drug intervention for chronic HBV infected liver tissue fibrosis

目的观察慢性乙型肝炎病毒(HBV)感染者应用恩替卡韦和拉米夫定治疗后的肝组织纤维化程度和炎症分级、肝功能的差异性。方法 110例慢性HBV感染患者随机分为恩替卡韦组和拉米夫定组,各55例。分别给予恩替卡韦、拉米夫定治疗。连续治疗30 d后行肝穿刺确诊肝组织纤维化程度和炎症分级。结果两组肝组织炎症分级比较,差异有统计学意义(P<0.05),恩替卡韦组以G1较多,拉米夫定组以G3较多。恩替卡韦组谷丙转氨酶(ALT)水平显著低于拉米夫定组,白蛋白水平显著高于拉米夫定组,差异均有统计学意义(P<0.05)。两组肝组织纤维化程度比较,差异有统计学意义(P<0.05),恩替卡韦组的免疫耐受期和清除期比例显著高于拉米夫定组,再活动期比例显著降低。结论恩替卡韦缓解和逆转慢性HBV感染肝组织纤维化进程较拉米夫定效果更佳。

Objective To observe differences of liver tissue fibrosis degree, inflammation grade, and liver function between entecavir and lamivudine in treatment for chronic hepatitis B virus（HBV） infected patients. Methods A total of 110 chronic HBV infected patients were randomly divided into entecavir group and lamivudine group, with 55 cases in each group. They respectively received entecavir and lamivudine for treatment. Liver puncture was taken after 30 d of treatment to diagnose liver tissue fibrosis degree and inflammation grade. Results The difference of inflammation grade between the two groups had statistical significance（P〈0.05）, and the entecavir group mainly showed G1, while the lamivudine group showed G3. The entecavir group had obviously lower alanine transaminase（ALT） and higher albumin levels than the lamivudine group. Their differences all had statistical significance（P〈0.05）. The difference of liver tissue fibrosis degree between the two groups had statistical significance（P〈0.05）. The entecavir group had much higher proportion of immune tolerant phase and immune clearance phase than the lamivudine group, while its proportion of reactivity phase was obviously lower than the lamivudine group. Conclusion Entecavir provides better effect in relieving and reversing chronic HBV infected liver tissue fibrosis.