不同核苷类抗病毒药物对乙型肝炎肝硬化的治疗效果评价

Evaluation of therapeutic effect of different nucleoside-based antiviral drugs on hepatitis B cirrhosis

目的探讨评价不同核苷类抗病毒药物在乙型肝炎肝硬化治疗中的疗效。方法选取136例乙型肝炎肝硬化患者作为研究对象,采用不同核苷类抗病毒药物进行治疗,并根据选用药物不同分为拉米夫定组(3TC组)、阿德福韦酯组(ADV组)、恩替卡韦组(ETV组)和替比夫定组(LDT组),每组34例。比较四组患者治疗前后肝功能指标[谷丙转氨酶(ALT)、总胆红素(TBIL)、白蛋白(ALB)、碱性磷酸酶(ALP)和谷草转氨酶(AST)]水平及不良反应发生情况。结果治疗后,四组患者的ALT、ALB、TBIL、AST、ALP水平均较治疗前改善,且3TC组和LDT组ALT水平均优于ADV组,ADV组ALB(46.34±8.55)g/L优于3TC组的(54.23±9.24)g/L、LDT组的(53.64±8.15)g/L、ETV组的(55.23±10.68)g/L,ETV组TBIL、ALP水平均优于ADV组和LDT组,3TC组TBIL、ALP水平优于ADV组,ETV组ALP水平优于3TC组,差异均具统计学意义(P<0.05)。四组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论不同核苷类抗病毒药物对乙型肝炎肝硬化患者的治疗效果各不相同,建议对乙型肝炎肝硬化患者的临床治疗时,优先使用ETV、3TC、LDT核苷类抗病毒药物进行治疗。

Objective To discuss and evaluate the efficacy of different nucleoside-based antiviral drugs on hepatitis B cirrhosis.Methods A total of 136 patients with hepatitis B cirrhosis as study subjects were treated with different nucleoside-based antiviral drugs.They were divided into lamivudine group(3 TC group),adefovir dipivoxil group(ADV group),entecavir group(ETV group)and telbivudine group(LDT group),with 34 cases in each group.The hepatic function indicators[alanine aminotransferase(ALT),total bilirubin(TBIL),albumin(ALB),alkaline phosphatase(ALP)and aspartate aminotransferase(AST)]levels before and after treatment and adverse reactions were compared among the four groups.Results After treatment,ALT,ALB,TBIL,AST and ALP levels of the four groups were improved than those before treatment,and ALT of 3 TC group and LDT group was better than that of ADV group.ALB(46.34±8.55)g/L of ADV group was better than that of 3 TC group(54.23±9.24)g/L,LDT group(53.64±8.15)g/L and ETV group(55.23±10.68)g/L.TBIL and ALP of ETV group was better than those of ADV group and LDT group,TBIL and ALP of 3 TC group was better than that of ADV group,and ALP of ETV group was better than that of 3 TC group.The difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of adverse reactions among the four groups(P>0.05).Conclusion Different nucleoside-based antiviral drugs have different therapeutic effects on patients with hepatitis B cirrhosis.It is recommended that ETV,3 TC,and LDT nucleoside antiviral-based drugs are preferred for clinical treatment of patients with hepatitis B cirrhosis.