三组核苷酸类药物在乙型肝炎后肝硬化治疗中的疗效比较

Efficacy comparison of three groups of nucleotides in the treatment of hepatocirrhosis after hepatitis B

目的观察不同核苷酸类药物治疗乙型肝炎后肝硬化的临床效果。方法 135例乙型肝炎肝硬化患者随机分为A、B、C三组。所有患者均根据病情给予护肝、利胆、降酶等综合治疗。A组患者在综合治疗的基础上加用拉米夫定治疗,B组患者加用阿德福韦酯治疗,C组患者加用恩替卡韦治疗。比较三组患者治疗前、后血清中的丙酸酸转氨酶(ALT),HBV DNA定量,HBV DNA定量,Child-Pugh评分,乙肝表面抗原阳性率及不良反应发生情况。结果治疗前,三组的ALT水平、Child-Pugh评分及HBV DNA载量无明显差异(P>0.05);治疗后,三组的上述指标显著低于治疗前,C组的改善情况优于A组和B组,而B组的ALT水平低于A组(P<0.05)。治疗前,三组的乙肝表面抗原阳性率无差异(P>0.05);治疗后,三组均有乙肝表面抗原部分转阴,C组的乙肝表面抗原转阴率高于A组和B组(P<0.05),但A组与B组乙肝表面抗原转阴率无差异(P>0.05)。三组的不良反应发生率无明显差异(P>0.05)。结论恩替卡韦治疗乙肝后肝硬化临床效果显著,不良反应少,值得临床推广应用。

Objective To observe the clinical effect of different nucleotide drugs in the treatment of liver cirrhosis after hepatitis B. Methods One hundred and thirty five cases of patients with hepatitis B cirrhosis were randomly divided into three groups A, B and C. All the patients were given liver protection, gallbladder, enzyme and other comprehensive treatment according to the condition of the liver. On the basis of the comprehensive treatment, the group A was treated with lamivudine, the group B was treated with adefovir dipivoxil, the group C received the entecavir. T （ALT）, HBV DNA ration, Child-Pugh scores, the positive rate of hepatitis B surface antigen and the occurrence of adverse reactions were observed in the three groups. Results Before the treatment, there were no significant differences in the ALT, HBV DNA ration, Child-Pugh scores in the three groups （P〉0.05）. After treatment, the three indicators improved in the three groups, and the indicators in the group C were better than those of the group A and B, the levels of ALT of the group B was better than that of the group A （P〈0.05）. Before treatment, there were no significant differences in the positive rate of hepatitis B surface antigen in the three groups （P〉0.05）. After treatment, part of the hepatitis B surface antigen turned negative, and the negative rate of hepatitis B surface antigen in group C was higher than that of group A and group B （P〈 0.05）, but there were no significant differences in group A and group B （P〉0.05）. There was no significant in the adverse reactions rate in the three groups （P〉0.05）. Conclusion The clinical effect entecavir in the treatment of liver cirrhosis after hepatitis B is remarkable, it has less adverse reactions, which is worthy of clinical popularization and application.