恩替卡韦对失代偿期乙型肝炎肝硬化患者肝功能及血清病毒学指标的影响

Effect of Entecavir on the Liver Function and Serum Virological Indexes of Patients with Decompensated Hepatitis B Cirrhosis

目的观察恩替卡韦治疗失代偿期乙型肝炎肝硬化患者72周内肝功能及血清病毒学指标的变化。方法将失代偿期乙型肝炎肝硬化患者92例按随机数字表法分为试验组和对照组,各46例,对照组常规内科治疗,试验组在常规治疗基础上加用恩替卡韦片。比较两组12、24、48、72周时肝功能指标、血清病毒学指标及ChildPugh评分,并观察患者临床结局。结果随治疗时间的延长,试验组丙氨酸氨基转移酶(ALT)、总胆红素(TBiL)值和Child-Pugh评分逐渐降低,差异有统计学意义(P<0.05或P<0.01),白蛋白(ALB)和凝血酶原活动度(PTA)值逐渐升高,差异有统计学意义(P<0.01)。治疗后同一时段,试验组ALT、TBiL值和Child-Pugh评分低于对照组(P<0.01);ALB和PTA值高于对照组,差异有统计学意义(P<0.01)。随治疗时间的延长,试验组HBV DNA值逐渐降低(P<0.01),同一时段明显低于对照组,差异有统计学意义(P<0.01)。72周时,试验组HBV DNA<500copies/mL者的比例、HBeAg阴转率、HBeAg/抗-HBe血清学阴转率均明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。试验组和对照组Child-Pugh C级患者死亡分别为3例(6.52%)和4例(8.70%),两组病死率比较差异无统计学意义(P>0.05)。结论恩替卡韦有助于改善失代偿期乙型肝炎肝硬化患者的肝功能,抑制HBV复制,提高HBeAg阴转率。

Objective To explore the effect of entecavir on the changes of liver function and serum virological indexes of patients with decompensated hepatitis B cirrhosis within 72 weeks .Methods Ninety‐two patients with decompensated hepatitis B cirrhosis were randomly divided into the experiment group （n=46） and the control group （n= 46） .Both groups were given routine treatment of internal medicine ,while the experiment group was given added Entecavir Tablets . The indexes of liver function , serum virological indexes and Child‐Pugh scores were compared in two groups at weeks 12 ,24 ,48 and 72 ,and the patients′clinical outcomes were also observed .Results With the growth of the treatment time ,the levels of alanine aminotransferase （ALT） and total bilirubin （TBiL） and the Child‐Pugh scores in the experiment group decreased significantly （P〈0.05 or P〈0.01） ,whereas the albumin level （ALB） and prothrombin activity （PTA） increased gradually ,and the differences were statistically significant （P〈0.01） .The levels of ALT and TBiL as well as the Child‐Pugh scores were significantly lower in the experiment group than those in the control group at the same stage （P〈0.01） ,but the ALB and PTA levels were significantly higher in the experiment group （P〈 0.01） .With the extension of the treatment ,HBV DNA value decreased gradually in the experiment group ,but it was significantly lower than that in the control group at the same point of time （ P〈 0.01 ） . At week 72 , the proportion of patients with HBV DNA less than 500 copies/mL , HBeAg negative‐transforming rate ,HBeAg/anti‐HBe serological negative‐transforming rate in the experiment group were significantly higher than those in the control group （P〈0.05 or P〈0.01） .There were 3 deaths （6.52% ） in the experiment group and 4 deaths （8.70% ） in the control group due to Child‐Pugh C ,and no significant differencewas shown by comparison to the fatality rates of two groups （P〉0.05） .Conclusion Entecavir is conductive to amelioration of the liver function ,rapid inhibition of HBV copy and improvement of HBeAg negative‐transforming rate in patients with decompensated hepatitis B cirrhosis .