前列地尔联合恩替卡韦治疗合并腹水的乙型肝炎肝衰竭效果观察

Clinical effect of alprostadil combined with entecavir in treatment of HBV-related liver failure complicated by ascites

目的观察前列地尔联合恩替卡韦治疗乙型肝炎肝衰竭合并腹水患者的临床效果。方法选取2011年9月-2014年6月于中国人民解放军九七医院住院治疗的乙型肝炎肝衰竭合并腹水患者84例,随机分为治疗组(n=42)和对照组(n=42)。两组患者均予保肝、退黄、利尿、白蛋白营养支持等常规治疗,对照组加用恩替卡韦,治疗组加用前列地尔和恩替卡韦联合治疗。观察记录患者治疗前后的肝功能指标(TBil、ALT、AST)、PTA、HBV DNA载量、临床疗效及24 h尿量和腹水消退情况。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 2组内治疗前后肝功能指标(TBil、ALT、AST)、PTA、HBV DNA水平比较差异均有统计学意义(P值均<0.05);治疗组与对照组间治疗后TBil、ALT、AST、PTA比较差异均有统计学意义[TBil:(197.4±47.6)μmol/L vs(287.5±150.6)μmol/L,t=2.30,P<0.05;ALT:(189.4±63.8)U/L vs(263.4±79.5)U/L,t=2.73,P<0.05;AST:(138.7±87.5)U/L vs(250.8±90.4)U/L,t=3.43,P<0.05;PTA:(63.5±17.0)%vs(45.5±15.1)%,t=2.60,P<0.05]。治疗组患者临床疗效的显效率和总有效率显著高于对照组(显效率:40.48%vs 28.57%,χ2=4.32,P<0.05;总有效率:85.71%vs66.67%,χ2=4.20,P<0.05);治疗组患者腹水消退情况的显效率和总有效率显著高于对照组(显效率:47.62%vs 23.81%,χ2=13.20,P<0.05;总有效率:88.10%vs 52.38%,χ2=12.81,P<0.05)。结论前列地尔联合恩替卡韦治疗乙型肝炎肝衰竭临床效果好,可有效改善预后,安全性好,值得推广。

Objective To investigate the clinical effect of alprostadil combined with entecavir in the treatment of HBV- related liver failure complicated by ascites. Methods A total of 84 patients with HBV- related liver failure complicated by ascites who were hospitalized and treated in No. 97 Hospital of PLA from September 2011 to June 2014 were enrolled and randomly divided into treatment group（ 42 patients）and control group（ 42 patients）. The patients in both groups were given conventional treatment for liver protection,jaundice clearance,diuresis,and albumin nutritional support. The patients in the control group were given entecavir in addition,while those in the treatment group were given alprostadil combined with entecavir in addition. The liver function parameters [total bilirubin（ TBil）,alanine aminotransferase（ ALT）,and aspartate aminotransferase（ AST） ],prothrombin activity（ PTA）,HBV DNA load,clinical outcome,24- hour urine volume,and ascites regression before and after treatment were observed and recorded. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Both groups had significant changes in the liver function parameters（ TBil,ALT,and AST）,PTA,and HBV DNA load after treatment（ all P〈0. 05）. There were significant differences in TBil,ALT,AST,and PTA after treatment between the treatment group and the control group（ TBil： 197. 4 ± 47. 6 μmol / L vs287. 5 ± 150. 6 μmol / L,t = 2. 30,P〈0. 05; ALT： 189. 4 ± 63. 8 U / L vs 263. 4 ± 79. 5 U / L,t = 2. 73,P〈0. 05; AST： 138. 7 ± 87. 5 U / L vs 250. 8 ± 90. 4 U / L,t = 3. 43,P〈0. 05; PTA： 63. 5% ± 17. 0% vs 45. 5% ± 15. 1%,t = 2. 60,P〈0. 05）. The treatment group had significantly higher marked response rate and overall response rate concerning clinical outcome than the control group（ marked response rate：40. 48% vs 28. 57%,χ2= 4. 32,P〈0. 05; overall response rate： 85. 71% vs 66. 67%,χ2= 4. 20,P〈0. 05）. The treatment group also had significantly higher marked response rate and overall response rate concerning ascites regression than the control group（ marked response rate： 47. 62% vs 23. 81%,χ2= 13. 20,P〈0. 05; overall response rate： 88. 10% vs 52. 38%,χ2= 12. 81,P〈0. 05）. Conclusion In patients with severe hepatitis B complicated by ascites,alprostadil combined with entecavir has good clinical effect and safety and can effectively improve the prognosis. Therefore,it holds promise for clinical application.