阿德福韦酯、拉米夫定联合微生态制剂治疗乙肝肝硬化的效果及对患者血清sICAM-1和血浆PKM2水平的影响

Effect of adefovir dipivoxil, lamivudine combined with microecological preparations on hepatitis B cirrhosis and its effect on serum sICAM-1 and plasma PKM2 levels

目的研究阿德福韦酯、拉米夫定联合微生态制剂治疗乙肝肝硬化的效果及对患者血清可溶性细胞间黏附分子-1(sICAM-1)和血浆丙酮酸激酶M2(PKM2)水平的影响。方法选取西安市北方医院消化科2013年1月至2017年1月期间收治的114例乙肝肝硬化患者,依据随机数表法分为观察和对照组,每组各57例,对照组采用阿德福韦酯和拉米夫定治疗,观察组在对照组治疗的基础上联合微生态制剂治疗。比较两组患者治疗24周后的肝功能指标、血清病毒学指标、肝纤维化指标的差异,以及血清sICAM-1和血浆PKM2水平,统计两组不良反应发生情况。结果两组患者治疗后的肝功能指标、肝纤维化指标均显著改善,其中观察组患者的血清谷草转氨酶(AST)、血清谷丙转氨酶(ALT)及总胆红素(TBIL)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)水平分别为(34.41±15.45)U/L、(38.41±7.92)U/L、(21.81±6.12)μmol/L、(114.43±23.41)ng/mL、(84.44±10.23)ng/mL,明显低于对照组(42.37±13.82)U/L、(50.37±10.88)U/L、(25.34±6.84)μmol/L、(172.33±31.84)ng/mL、(102.57±19.43)ng/mL,差异均有统计学意义(P<0.05);两组患者治疗后的乙型肝炎病毒(HBV)DNA和乙型肝炎e抗原(HBeAg)转阴率逐步提高,治疗至24周时,观察组患者的HBV-DNA转阴率和HBeAg转阴率分别为94.73%、36.84%,明显高于对照组78.95%、19.30%,差异均有统计学意义(P<0.05);两组患者治疗后的血清sICAM-1和血浆PKM2水平明显降低,其中观察组分别为(188.35±52.26)μg/L、(24.65±5.17)U/L,明显低于对照组的(210.67±55.71)μg/L、(35.36±4.81)U/L,差异均有统计学意义(P<0.05);观察组和对照组患者不良事件发生情率分别为14.04%、12.96%,差异无统计学意义(P>0.05)。结论阿德福韦酯、拉米夫定联合微生态制剂治疗乙肝肝硬化的效果显著,其可有效提高HBV-DNA、HBeAg转阴率,降低血清sICAM-1和血浆PKM2水平,从而降低炎症反应,改善肝功能和肝纤维化,值得临床推广。

Objective To study the effect adefovir dipivoxil, lamivudine combined with microecological preparations on hepatitis B cirrhosis and its effect on serum soluble intercellular adhesion molecule-1 (sICAM-1) and plasma pyruvate kinase M2 (PKM2) levels. Methods A total of 114 patients with hepatitis B cirrhosis admitted to the Department of Gastroenterology, the Northern Hospital of Xi'an City from January 2013 to January 2017 were selected and divided into an observation and a control group according to random number table, with 57 patients in each group. The patients in the control group were treated with adefovir dipivoxil and lamivudine, while the patients in the observation group were additionally treated with microecological preparation on the basis of the control group. The liver function, serum virology, hepatic fibrosis, serum sICAM-1, and plasma PKM2 were compared between the two groups after 24 weeks of treatment, and the incidence of adverse reactions in the two groups was statistically analyzed. Results The indexes of liver function and hepatic fibrosis in the two groups were significantly improved after treatment, among which the levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), hyaluronic acid (HA), collagen type Ⅳ(Ⅳ-C) in the observation group were (34.41±15.45) U/L,(38.41±7.92) U/L,(21.81±6.12)μmol/L,(114.43±23.41) ng/mL,(84.44±10.23) ng/mL, significantly lower than (42.37±13.82) U/L,(50.37±10.88) U/L,(25.34±6.84)μmol/L,(172.33± 31.84) ng/mL,(102.57±19.43) ng/mL in the control group (P<0.05). The negative rate of HBV-DNA and HBeAg in two groups was gradually increased, and the negative conversion rate of HBV-DNA (94.73%) and HBeAg (36.84%) in the observation group was significantly better than those in the control group (78.95%, 19.30%) at 24 weeks after treatment (P< 0.05). The levels of serum sICAM-1 and plasma PKM2 in both groups were significantly decreased after treatment, and the levels of the observation group were (188.35±52.26)μ g/L,(24.65±5.17) U/L, significantly lower than (210.67± 55.71)μg/L,(35.36 ±4.81) U/L in the control group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (14.04% vs 12.96%, P>0.05). Conclusion The effect of microecological preparation combined with adefovir dipivoxil and lamivudine on hepatitis B cirrhosis is significant. It can effectively improve the negative rate of HBV-DNA and HBeAg and reduce serum sICAM-1 and plasma PKM2 levels, thus reduce the inflammatory reaction and improve liver function and liver fibrosis, which is worth popularizing in clinic.