恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水的效果观察

Efficacy of entecavir combined with alprostadil in treatment of hepatitis B-related cirrhotic ascites

目的观察恩替卡韦与前列地尔联合治疗乙型肝炎肝硬化腹水的临床疗效。方法选取2012年5月-2014年2月德州市中医院收治的乙型肝炎肝硬化腹水患者100例,随机分为治疗组与对照组,每组各50例,两组均常规给予保肝、利尿、间断补充白蛋白(Alb)治疗,其中治疗组加用恩替卡韦0.5 mg口服,1次/d,联合前列地尔20μg+5%葡萄糖注射液100 ml静滴,1次/d,观察组只加用恩替卡韦0.5 mg口服,1次/d。住院治疗4周,观察两组治疗前后腹水消退情况、ALT、TBil、Alb、血液尿素氮(BUN)、肌酐(Cr)、凝血酶原活动度(PTA)、HBV DNA水平变化。出院后两组患者继续口服恩替卡韦0.5 mg,1次/d,随访3个月观察远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者治疗后腹水量较治疗前均有不同程度降低,治疗组总有效率(84%)高于对照组(64%),差异有统计学意义(χ2=6.018,P<0.05);两组患者肝肾功能各项指标(ALT、TBil、Alb、BUN、Cr)及PTA治疗后较治疗前均有不同程度改善,且治疗组疗效优于对照组,两组治疗后各项指标相比差异均有统计学意义(t值分别为7.567、6.875、-4.782、6.786、8.542、8.976,P值均<0.01);两组患者治疗后HBV DNA水平均较治疗前有不同程度下降,差异均有统计学意义(t值分别为8.976、5.758,P值均<0.01)),但两组间治疗后比较差异无统计学意义(P>0.05);患者出院后随访3个月,治疗组在肝肾功能稳定、腹水反复方面优于对照组。结论恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水疗效确切,远期疗效较好,值得临床应用与推广;恩替卡韦单用对肾功能改善不明显,但肝功能可获得明显改善。

Objective To investigate the efficacy of entecavir combined with alprostadil in the treatment of hepatitis B - related cirrhotic as- cites. Methods A total of 100 patients with hepatitis B - related cirrhotic ascites who were admitted to Dezhou Hospital of Traditional Chi- nese Medicine from May 2012 to February 2014 were selected and randomly divided into treatment group and control group, with 50 patients in each group. The patients in both groups received the liver -protecting treatment, diuretic treatment, and intermittent supplementation of albumin（ Alb）. Additionally, the patients in the treatment group received oral entecavir 0.5 mg once a day, combined with intravenous infu- sion of alprostadil 20 μg ＋ 5% glucose injection 100 ml once a day, and those in the observation group only received oral entecavir 0.5 mg once a day. The patients were hospitalized and treated for 4 weeks. Ascites regression, changes in the levels of alanine aminotransferase （ALT） , total bilirubin （TBil） , Alb, blood urea nitrogen （BUN） , creatinine （Cr） , and hepatitis B virus （HBV） DNA, and prothromhin activity （PTA） were observed in both groups. After discharge, the patients in both groups continued to take oral entecavir 0.5 mg once a day, and the long - term therapeutic effect was observed through follow - up for 3 months. The t - test was applied for comparison of continu- ous data between groups, and the chi - square test was applied for comparison of categorical data between groups. Results The patients in both groups had varying degrees of reduction in the amount of ascites after treatment, and the treatment group had a significantly higher over- all response rate than the control group （X2 = 6. 018, P 〈 0.05 ）. The patients in both groups had varying degrees of improvement in each in- dex of liver and renal function （ALT, TBil, Alb, BUN, and Cr） and PTA after treatment; the treatment group had a better treatment out- come than the control group, and there were significant differences in each index after treatment between the treatment group and the control group （t = 7. 567, 6. 875, -4. 782, 6. 786, 8. 542, and 8. 976, all P 〈 0.01）. The patients in both groups had varying degrees of reduction in HBV DNA level after treatment （t = 8. 976 and 5. 758, both P 〈 0.01 ）, but HBV DNA level showed no significant difference between the two groups after treatment （P 〉 0.05 ）. The patients were followed up for 3 mouths after discharge, and the treatment group had a better treatment outcome than the control group in terms of stabilization of liver and renal function and recurrence of ascites. Conclusion Ente- cavir combined with alprostadil has a good therapeutic effect in hepatitis B - related cirrhotic ascites, as well as a good long - term effect, and is worthy of clinical application. Entecavir monotherapy does not improve renal function significantly, but can improve liver function sig- nificantly.