Fibroscan评价去甲斑蝥素片联合TDF治疗乙型肝炎肝硬化临床疗效的研究

Clinical Effect of Norcantharidin Tablets Combined with TDF in Treatment of Patients with Hepatitis B Virusrelated Cirrhosis evaluated by Fibroscan

目的观察瞬时弹性成像系统(Fibroscan)在去甲斑蝥素片联合替诺福韦酯(TDF)治疗乙型肝炎肝硬化疗效评价中的价值。方法选择2016年6月—2017年10月收治的120例慢性乙型肝炎肝硬化,按治疗方法分为观察组和对照组,每组60例。对照组给予抗炎保肝药物治疗,同时口服TDF抗乙型肝炎病毒治疗,治疗组在此基础上加服去甲斑蝥素片抗肝硬化治疗。2组用药疗程均为6个月。2组治疗前后均以Fibroscan检测肝脏弹性测量值(LSM),检测肝功能、凝血功能、血常规、门静脉内径宽度,观察Child-Pugh评分变化。分析肝硬化LSM与Child-Pugh分级的相关性。结果 2组治疗后丙氨酸转氨酶、天冬氨酸转氨酶、谷氨酰转肽酶、总胆红素、门静脉内径宽度、ChildPugh评分及LSM均低于治疗前,白蛋白(ALB)高于治疗前,观察组治疗后凝血酶原时间(PT)低于治疗前(P <0. 05,P <0. 01)。观察组治疗后ALB、门静脉内径宽度高于对照组,Child-Pugh评分及LSM低于对照组(P <0. 05,P <0. 01)。Child-Pugh A级患者治疗前后LSM水平均低于Child-Pugh B、C级患者(P <0. 01)。治疗前后肝硬化LSM与Child-Pugh分级均呈正相关(r=0. 492、0. 512,P <0. 01)。2组均未发生严重不良反应。结论去甲斑蝥素片联合TDF可显著改善慢性乙型肝炎肝硬化患者的肝功能,控制肝硬化进展。以Fibroscan动态检测LSM可有效评估乙型肝炎肝硬化患者治疗效果及病情变化。

Objective To observe value of transient resilience imaging system (Fibroscan) in evaluation of efficacy of Norcantharidin Tablets combined with Tenofovir (TDF) in treatment of patients with hepatitis B virus-related cirrhosis. Methods A total of 120 patients with chronic hepatitis B virus-related cirrhosis admitted during June 2016 and October 2017 were divided into observation group and control group ( n =60 in each group) according to therapeutic methods. Control group received antiinflammatory hepatic protectant drugs and TDF orally simultaneously, while treatment group was added Norcantharidin Tablets on the basis of treatment for control group. Courses of treatment were 6 months in two groups. Liver stiffness measurement (LSM) values were measured by Fibroscan before and after treatment in two groups. Liver function, blood routine and portal vein internal diameter width were detected, and changes of Child-Pugh score were observed, and correlation between cirrhosis with Child-Pugh was analyzed in two groups. Results After treatment, levels of alanine aminotransferase, aspartate aminotransferase , glutamyl transpeptidase, total bilirubin, portal vein internal diameter width, Child-Pugh score and LSM value were significantly lower, while albumin (ALB) levels were significantly higher than those before treatment in two groups;prothrombin time (PT) was shorter than that before treatment in observation group ( P <0.05, P <0.01). After treatment, in observation group, ALB and portal vein internal diameter width levels were significantly higher, while Child-Pugh score and LSM value were significantly lower than those in control group ( P <0.05, P <0.01). LSM values of patients with Child-Pugh grade A before and after treatment were significantly lower than those of patients with Child-Pugh grade B and C ( P <0.01). LSM was positively correlated with Child-Pugh classification before and after treatment ( r =0.492 and 0.512, P <0.01). There were no serious adverse reactions in two groups. Conclusion Norcantharidin Tablets combined with TDF may obviously improve liver function of patients with HBV-related cirrhosis and prevent progression of cirrhosis. Fibroscan dynamic detection of LSM can be used in evaluation of treatment effectiveness and changes of pathogenetic conditions in patients with hepatitis B virus-related cirrhosis.