恩替卡韦治疗HBeAg阴性代偿期慢性乙型肝炎肝硬化的效果分析

Clinical efficacy of entecavir in HBeAg-negative chronic hepatitis B with compensated cirrhosis

目的探讨恩替卡韦(ETV)治疗HBe Ag阴性代偿期慢性乙型肝炎肝硬化患者96周的临床效果及其对不同HBV DNA载量患者的影响。方法选取2009年1月-2013年6月于襄阳市中医医院就诊的HBe Ag阴性代偿期慢性乙型肝炎肝硬化患者共118例,Child-Pugh评分为A级,根据HBV DNA载量分为高载量组(A组):HBV DNA≥105拷贝/ml和低载量组(B组):HBV DNA<105拷贝/ml。给予恩替卡韦0.5 mg/d治疗96周,所有患者治疗前后采用Child-Pugh评分评价肝功能,观察患者治疗前后ALT、白蛋白(Alb)、TBil变化。通过透明质酸、α2巨球蛋白、肝脏硬度测量值(LSM)评估肝纤维化情况。计量资料组间比较采用t检验,不同时间点组内和组间比较采用重复测量数据方差分析。计数资料组间比较采用χ2检验。结果两组血清ALT、Alb、TBil在治疗第12、24周显著下降(χ2值分别为9.241、6.428、11.134、5.139,P值均<0.05),两组ALT复常率和HBV DNA阴转率在治疗第24、48周差异均具有统计学意义(t值分别为2.648、1.921、4.018、3.166、2.136、3.461,P值均<0.05)。两组透明质酸、α2巨球蛋白和LSM在治疗后显著下降,差异均具有统计学意义(P值均<0.05)。两组并发症如静脉曲张出血、腹水、肝细胞癌发生率比较差异均无统计学意义(P值均>0.05)。结论恩替卡韦治疗HBe Ag阴性代偿期慢性乙型肝炎肝硬化患者可显著改善其肝功能,减缓肝纤维化及肝硬化进程,有效降低远期并发症。

Objective To investigate the clinical efficacy of 96- week entecavir（ ETV） treatment for HBe Ag- negative chronic hepatitis B patients with compensated cirrhosis,as well as its effect on patients with different HBV DNA loads. Methods A total of 118 chronic hepatitis B patients with compensated cirrhosis who visited Xiangyang Hospital of Traditional Chinese Medicine from January 2009 to June 2013 were enrolled and all had Child- Pugh class A cirrhosis. According to HBV DNA load,these patients were divided into high- load group（ group A,HBV DNA≥105copies / ml） and low- load group（ group B,HBV DNA 105 copies / ml）. All the patients were treated with ETV 0. 5 mg / d for 96 weeks. Child- Pugh score was used to evaluate liver function before and after treatment,and the changes in alanine aminotransferase（ ALT）,albumin（ Alb）,and total bilirubin（ TBil） after treatment were observed. Hyaluronic acid（ HA）,α2- macroglobulin,and liver stiffness measurement（ LSM） were used to evaluate liver fibrosis. The t- test was used for comparison between groups,and a repeated- measures analysis of variance was used for comparison within one group and between groups at different time points. Chisquare test was applied for comparison of categorical data between the two groups. Results The two groups showed significant reductions in ALT,Alb,and TBil at weeks12 and 24 of treatment（ all P〈0. 05）,and the ALT normalization rate and HBV DNA clearance rate at weeks 24 and 48 of treatment showed significantly differences between the two groups（ χ2= 9. 241,6. 428,11. 134,5. 139,all P〈0. 05）. Both groups showed significant reductions in HA,α2- macroglobulin,and LSM after treatment（ t = 2. 648,1. 921,4. 018,3. 166,2. 136,3. 461,all P〈0. 05）. The incidence rates of complications such as variceal bleeding,ascites,and hepatocellular carcinoma showed no significant differences between the two groups（ all P〈0.05）. Conclusion In HBe Ag- negative chronic hepatitis B patients with compensated cirrhosis,ETV can significantly improve liver function,slow down the process of liver fibrosis and cirrhosis,and effectively reduce long- term complications.