瞬时肝弹性测定技术评价替比夫定治疗乙肝早期肝硬化疗效研究

Assessment of the efficacy of telbivudine in the treatment of early stage liver cirrhosis due to Hepatitis B by transient liver elasticity

目的:探讨瞬时肝弹性测定技术评估替比夫定治疗慢性乙型肝炎早期肝硬化(简称早期肝硬化)患者肝纤维化的临床疗效。方法:对53例早期肝硬化患者给予替比夫定600mg/次治疗,1次/d,疗程为6个月;检测入组患者治疗前后肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、前白蛋白(PA)、总胆红素(TBIL)、谷氨酰转肽酶(γ-GT)含量及HBV转阴率;采用Fibroscan测定入组患者治疗前后肝弹性变化;采用肝穿刺活检分析入组患者治疗前后肝脏纤维化分级;采用放射免疫方法测定入组患者治疗前后血清III型前胶原(PⅢP)、IV型胶原透明质酸(HA)、层连蛋白(LN)含量,观察并分析其变化。结果:替比夫定治疗早期肝硬化总有效率为75.47%。与治疗前相比,治疗后患者血清ALT、AST、γ-GT、TBIL、PⅢP、HA、LN含量降低,ALB、PA含量升高(P<0.05);与治疗前肝纤维化评分为(1.94±1.04)分相比治疗后(1.49±0.77)纤维化评分明显降低(P<0.05);与治疗前HBV-DNA拷贝量[(21.64±4.45)copies/ml]相比,治疗后为[(6.62±1.45)copies/ml]明显降低(P<0.05);与治疗前患者瞬时肝弹性F值(19.34±1.56)kPa相比,治疗后F值(9.31±1.04)kPa明显降低;治疗前后入组患者瞬时肝弹性F值与血清ALT、AST、γ-GT、TBIL、PⅢP、HA、LN、肝组织纤维化分期评分、HBV-DNA拷贝量均呈正相关,与ALB、PA呈负相关(P<0.05)。结论:瞬时肝弹性测定技术评估替比夫定治疗慢性乙肝早期肝硬化肝功能及纤维化有较高评估价值,但评估HBV-DNA拷贝量仅有一定的参考价值。

Objective： To evaluate the clinical efficacy of telbivudine in the treatment of liver fibrosis in patients with chronic Hepatitis Bliver cirrhosis （early stage cirrhosis） by transient liver elasticity. Methods： Fifty - three patients with early liver cirrhosis were treated with telbivudine 600 mg once daily for 6 months. The indexes of liver function such as ALT, AST, ALB, PA, TBIL, γ-GT content and HBV negative rate; fibroscan was measured before and after treatment in patients with liver elastic changes;liver biopsy was used to analyze the classification of liver fibrosis before and after treatment. Radioimmunoassay was used to determine the levels of serum type III procollagen （PⅢP）, type IV collagen hyaluronic acid （HA） and laminin （LN） before and after treatment. Results： Compared with those before treatment, the levels of serum ALT, AST, γ- GT, TBIL, PⅢP, HA and LN was decreased and the levels of ALB and PA was increased （ P 〈0.05）. Fibrosis score （1.49±0.77） was significantly lower than that before treatment （1.94 ± 1.04） （ P 〈0.05）. Compared with the HBV-DNA copy number before treatment[（21.64±4.45） copies / ml], after treatment [（6.62±1.45） copies / ml] were significantly lower than those before treatment （ P 〈0.05）. Compared with the instantaneous hepatic elasticity F （19.34± 1.56） kPa in patients before treatment, the F value （9.31±1.04） kPa after treatment was significantly decreased. The F value of transient hepatic elasticity before and after treatment was positively correlated with serum ALT, AST, γ-GT, TBIL, PⅢP, HA, LN, fibrosis staging score and HBV-DNA copy number, and ALB, PA was negatively correlated （ P 〈0.05）. Conclusion： The assessment of transient liver elasticity provides a high evaluation value of telbivudine for the treatment of hepatic function and fibrosis in cirrhotic patients with chronic hepatitis B, but there is only a certain reference value for assessing HBV-DNA copy number.