恩替卡韦与阿德福韦酯对乙型病毒性肝炎失代偿性肝硬化患者甲状腺功能和肝功能的影响

Effect of entecavir and adefovir dipivoxil on thyroid function and liver function in patients with decompensated hepatitis B cirrhosis

目的探讨恩替卡韦与阿德福韦酯对乙型病毒性肝炎失代偿性肝硬化患者临床疗效、甲状腺功能及肝功能的影响.方法选取浙江中医药大学附属第二医院从2014-09/2016-09收治的120例乙型病毒性肝炎失代偿性肝硬化患者,按随机数字表法均分为两组:两组均给予常规治疗,对照组60例,在常规治疗基础上给予阿德福韦酯治疗;观察组60例,在常规治疗基础上给予恩替卡韦治疗.治疗3、6和12 mo后,观察两组患者的乙型肝炎病毒(hepatitis B virus,HBV)DNA转阴率、乙型肝炎e抗原(hepatitis B e antigen,HBe Ag)转阴率、ChildPugh评分、肝功能、甲状腺功能、并发症发生率、死亡率及药物不良反应发生率等.结果治疗3、6及12 mo后,观察组HBV DNA转阴率明显高于对照组,差异具有统计学意义(P<0.05);两组HBe Ag转阴率差异均无统计学意义(P>0.05);治疗12 mo后,观察组Child-Pugh评分明显低于对照组,差异具有统计学意义(P<0.05).两组患者谷丙转氨酶、谷草转氨酶、总胆红素水平均明显低于治疗前(P<0.05),且观察组明显低于对照组,差异具有统计学意义(P<0.05).两组患者治疗1年后,T3、T4、FT3、FT4表达水平均高于治疗前水平(P<0.05),且观察组明显高于对照组,差异具有统计学意义(P<0.05);TSH明显低于治疗前水平,且观察组明显低于对照组,差异具有统计学意义(P<0.05).两组患者并发症总发生率、总死亡率差异无统计学意义(P>0.05),但观察组均略低于对照组;两组未出现严重药物不良反应.结论恩替卡韦对乙型肝炎肝硬化失代偿的患者的临床疗效显著,同时能够改善肝功能及甲状腺功能,且安全性好,值得推广应用.

AIM To explore the effect of entecavir and adefovir dipivoxil on thyroid function and liver function in patients with decompensated hepatitis B cirrhosis.METHODS One hundred and twenty patients with decompensated hepatitis B cirrhosis treated from September 2014 to September 2016 at our hospital were randomly divided into an observation group （n = 60） and a control group （n = 60）. Both groups received conventional treatment. The control group was additionally given adefovir dipivoxil, and the observation group was given entecavir. At 3, 6, and 12 mo after treatment, hepatitis B virus （HBV） DNA negative rate, HBeAg negative rate, Child-Pugh score, liver function, thyroid function, the incidence of complications, mortality, and the incidence of adverse drug reactions were observed.RESULTS At 3, 6, and 12 mo after treatment, HBV DNA negative rates were significantly higher in the observation group than in the control group （P 〈 0.05）, although there was no significant difference in hepatitis B e antigen negative rates （P 〉 0.05）; the Child-Pugh scores and serum levels of alanine transaminase, aspartate transaminase, and total bilirubin were significantly lower in the observation group than in the control group （P 〈 0.05）. After treatment for 1 year, the levels of T3, T4, FT3, and FT4 were significantly higher and that of TSH was significantly lower in the observation group than in the control group （P 〈 0.05）. There was no significant difference in the incidence of complications or mortality （P 〉 0.05）, and no severe adverse reactions were observed in either group.CONCLUSION Entecavir is significantly effective in patients with decompensated hepatitis B cirrhosis and can improve liver function and thyroid function with good safety.