特异性免疫活性细胞联合替比夫定治疗难治性乙型肝炎的临床研究

Clinical study of specific immunocompetent cells combined with telbivudine in the treatment of refractory hepatitis B

目的分析特异性免疫活性细胞联合替比夫定治疗难治性乙型肝炎的临床疗效，旨在为临床治疗难治性乙型肝炎提供临床依据。方法收集2012年1月至2015年12月在本院确诊的难治性乙型肝炎患者共160例作为受试对象，随机分为对照组和观察组。对照组单独使用替比夫定，共持续24周；观察组患者使用DC-CIK回输治疗联合替比夫定治疗。分析治疗前后两组患者的谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBIL）、白蛋白（ALB）等肝功能指标；HBeAg定量以及HBV-DNA定量，并评价两组患者的疗效差异。结果对照组和观察组治疗前后ALT、AST、TBIL和ALB水平差异有统计学意义（P＜0.05），观察组治疗后ALT、AST、TBIL和ALB水平显著低于对照组（P＜0.05）。对照组和观察组治疗后HBV-DNA定量和HBeAg定量均显著低于治疗前（P＜0.05），观察组治疗后HBV-DNA和HBeAg定量显著低于对照组（P＜0.05）。对照组治疗后总有效率为60.00%，观察组治疗后总体有效率87.50%，两者相比差异有统计学意义（P＜0.05）。结论联合使用特异性免疫活性细胞和替比夫定较单独使用替比夫定能够显著增加患者的肝功能指标，并显著降低患者的乙肝病毒数量，提高疗效，值得临床推广使用。

Objective To analyze the clinical efficacy of specific immunocompetent cells combined with telbivudine in the treatment of refractory hepatitis B, provide clinical basis for clinical treatment of refractory hepatitis B. Methods 160 cases of refractory hepatitis B diagnosed in our hospital from January 2012 to December 2015 were selected as observation subjects, and randomly divided into control group and observation group. Control group was given telbivudine alone, a total of 24 weeks; and observation group was given DC-CIK transfusion therapy combined with telbivudine treatment. Analyzed alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, albumin （ALB）, and other liver function indexes of patients before and after treatment, HBeAg quantitative and HBV-DNA quantitative, evaluated the outcome of patients. Results There were statistically significant differences in the levels of ALT, AST, TBIL, ALB before and after treatment in control group and observation group （P〈0.05）, the levels ofALT, AST, TBIL, ALB in observation group after treatment were significantly lower than those in control group （P〈0.05）. HBeAg quantitative and HBV-DNA quantitative after treatment were significantly lower than those before treatment in control group and observation group （P〈0.05）, HBeAg quantitative and HBV-DNA quantitative in observation group after treatment were significantly lower than those in control group （P〈0.05）. The total effective rate after^treatment in control group was 60.00%, 87.50% in observation group, with statistically significant difference between two groups （P〈0.05）. Conclusions Compared with telbivudine alone, combined use of specific immunocompetent cells and telbivudine can significantly increase patients＇ liver function, significantly reduce the amount of hepatitis B virus in patients, improve efficacy, worthy of clinical use.