恩替卡韦联合聚乙二醇干扰素α2a治疗乙型病毒性肝炎的效果及对患者血清YKL-40、CEA水平的影响

Efficacy of entecavir combined with polyethylene glycol interferon α2a in the treatment of viral hepatitis B and its effect on the level of serum human cartilage glycoprotein 39, carcinoembryonic antigen

目的探讨恩替卡韦联合聚乙二醇干扰素α2a治疗乙型病毒性肝炎的效果及对患者血清人软骨糖蛋白-39(YKL-40)、癌胚抗原(CEA)水平的影响。方法选取2016年5月至2017年4宜宾市第二人民医院传染一科收治的慢性乙型病毒性肝炎患者82例,采用随机数表法分为对照组和观察组,每组41例,对照组患者予以聚乙二醇干扰素α2a治疗,观察组患者在此基础上加用恩替卡韦治疗,两组均连续治疗12个月。比较两组患者的临床疗效、HBVDNA转阴情况和并发症发生率,以及治疗前后两组患者的血清YKL-40、CEA、肿瘤坏死因子-α(TNF-α)及肝功能水平。结果观察组患者的治疗总有效率为95.13%,明显高于对照组的56.10%,差异具有统计学意义(P<0.05);治疗后,观察组和对照组患者的血清YKL-40[(26.62±19.51)ng/mLvs(36.55±20.61)ng/mL]、CEA[(1.13±0.07)μg/Lvs(1.20±0.09)μg/L]、TNF-α[(59.18±7.38)ng/Lvs(80.37±10.06)ng/L]、ALT[(60.07±8.38)U/Lvs(72.48±9.08)U/L]、AST[(52.09±6.48)U/Lvs(73.28±9.19)U/L]水平比较,观察组均明显低于对照组,差异均具有统计学意义(P<0.05);治疗后,观察组患者的HBVDNA转阴率为43.9%,明显高于对照组的4.88%,差异具有统计学意义(P<0.05);两组患者的腹水、肺部感染、自发性腹膜炎、肝性脑病、肝肾综合征及胆囊炎发生率比较差异均无统计学意义(P>0.05)。结论恩替卡韦联合聚乙二醇干扰素α2a治疗乙肝可提升治疗效果,同时抑制患者YKL-40、CEA、TNF-α的表达,可能是改善肝功提高患者转阴率的关键所在。

Objective To investigate the efficacy of entecavir combined with polyethylene glycol interferon α 2a in the treatment of viral hepatitis B and its effect on the level of serum human cartilage glycoprotein 39 (YKL-40), carcinoembryonic antigen (CEA). Methods From May 2016 to April 2017, 82 patients with chronic viral hepatitis B who admitted to the First Department of Department of Infectious Disease, the Second People's Hospital of Yibin were divided into the control group and observation group according to random number table method, with 41 cases in each group. The patients in the control group were treated with pegylated interferon α2a, and the patients in the observation group were treated with entecavir. Both groups were treated continuously for 12 months. The clinical effect, hepatitis B virus (HBV) DNA turning negative were compared between two groups. The level of serum YKL-40, CEA, tumor necrosis factor-α(TNF-α) and liver function were compared before and after treatment. Results Compared with the total effective rate of control group (56.10%), the total effective rate in the observation group was significantly higher (95.13%). After treatment, the levels of serum YKL-40, CEA, TNF-α, alanine aminotransferase (ALT), aspartate aminotransferase (AST) in the observation group were (26.62±19.51) ng/mL,(1.13±0.07)μ g/L,(59.18±7.38) ng/L,(60.07±8.38) U/L,(52.09±6.48) U/L, respectively, which were significantly lower than corresponding (36.55±20.61) ng/mL,(1.20±0.09)μg/L,(80.37±10.06) ng/L,(72.48±9.08) U/L,(73.28±9.19) U/L in the control group (all P<0.05);the negative conversion rate of HBV DNA in the observation group was 43.9%, which was significantly higher than 4.88% in the control group (P< 0.05);there was no significant difference in the incidence of ascitic fluid, pulmonary infection, spontaneous peritonitis, hepatic encephalopathy, hepatorenal syndrome and cholecystitis between the observation group and the control group (all P>0.05). Conclusion Entecavir combined with polyethylene glycol interferon α2a can improve the therapeutic effect of hepatitis B and inhibit the expression of YKL-40, CEA, TNF-α in patients, which may be the key to improve liver function and increase the negative rate of patients.