恩替卡韦治疗乙肝肝硬化失代偿期的临床研究

Clinical Study on Entecavir in Treatment of Decompensated Cirrhosis of Hepatitis B

目的研究恩替卡韦治疗乙肝肝硬化失代偿期的临床效果。方法方便选取该院于2014年3月—2017年3月所收治的37例失代偿期乙肝肝硬化患者,在行常规基础治疗的同时给予患者恩替卡韦治疗,连续治疗48周。观察患者临床症状的改善情况及并发症的发生情况,比较患者治疗前后周肝功能变化情况,HbeAg、HBV血清标志物、Child-Pugh评分变化情况及HBV-DNA的转阴率。结果患者经治疗后,临床症状明显缓解;患者TBIL、ALT及AST水平[(21.2±9.6)mol/L、(31.8±15.1)U/L、(52.03±5.24)U/L]较治疗前[(31.2±16.3)mol/L、(94.3±55.2)U/L、(126.98±42.89)U/L]明显下降(t=5.624, P<0.05;t=15.481, P<0.05;t=12.336, P<0.05;),ALB水平[(38.4±4.7)g/L]较治疗前[(33.6±6.5)g/L]明显上升(t=3.043, P<0.05);HbeAg的转阴率为18.75%;HBV-DNA水平较治疗前[(3.2±0.7) logcopies/mL vs(6.2±1.3)logcopies/mL]明显下降(t=4.831;P<0.05),转阴率为81.08%;Child-Pugh评分较治疗前[(5.5±0.8)分vs(9.3±1.7)分]也明显下降(t=7.427;P<0.05);并发症的发生率由治疗前的94.59%降低至8.11%,治疗前后比较,差异有统计学意义(χ~2=23.364;P<0.05)。结论针对失代偿期乙肝肝硬化患者,利用恩替卡韦进行治疗可有效改善患者临床症状及肝功能状况,阻止病情的发展,同时其并发症的发生率减少,值得在临床治疗当中推广应用。

Objective To research the clinical effect of entecavir in treatment of decompensated cirrhosis of hepatitis B. Methods 37 cases of patients with decompensated cirrhosis of hepatitis B admitted and treated in our hospital from March 2014 to March 2017 were convenient selected, and the patients were treated with entecavir on the basis of the routine basic therapy, for 48 weeks in a row, and the improvement of clinical symptoms and occurrence of complications of patients were observed, and the liver function changes, HbeAg, HBV serum markers, Child-Pugh score changes and HBV-DNA negative rate were compared before and after treatment. Results After treatment, the clinical symptoms were obviously relived, and the TBIL, ALT, AST levels of patients obviously decreased, compared with those before treatment[（21.2±9.6）mol/L,（31.8±15.1）U/L, （52.03±5.24）U/L] vs [（31.2±16.3）mol/L, （94.3±55.2）U/L, （126.98±42.89）U/L],（t=5.624, P〈 0.05;t=15.481, P〈 0.05;t=12.336, P〈0.05）, and the ALB level obviously increased compared with that before treatment[（38.4±4.7）g/L vs （33.6±6.5）g/L], （t=3.043, P〈 0.05）, and the HbeAg negative rate and HBV-DNA level obviously decreased compared with those before treatment[18.75%, （3.2±0.7） logcopies/mL vs（6.2±1.3）logcopies/mL] （t=4.831;P〈 0.05）, and the negative rate was 81.08%, and the Child-Pugh score obviously decreased compared with those before treatment[（5.5±0.8）points vs （9.3±1.7）points],（t=7.427;P〈0.05） and the incidence rate of complications decreased from 94.59% before treatment to 8.11% after treatment, and the difference before and after treatment was statistically significant（χ^2=23.364;P〈0.05）. Conclusion The entecavir treatment can effectively improve the clinical symptoms and liver function state for patients with decompensated cirrhosis of hepatitis B, prevent the development of diseases, and it can also reduce the incidence rate of complications, and it is worth promotion and application in clinical treatment.