替诺福韦酯联合鳖甲煎丸治疗慢性乙型肝炎纤维化

Tenofovir Disoproxil Fumarate Combined with Biejiajian Pills for Liver Fibrosis in Patients with Chronic Hepatitis B

目的研究替诺福韦酯联合鳖甲煎丸治疗慢性乙型肝炎(乙肝)肝纤维化患者的临床效果。方法回顾性分析慢性乙肝肝纤维化患者80例,依据治疗方式不同,将其分为试验组与对照组,试验组40例在富马酸替诺福韦二吡呋酯片治疗的基础上加用鳖甲煎丸;对照组40例给予富马酸替诺福韦二吡呋酯片治疗。对比2组治疗前和治疗不同时期(治疗12、24、36和48周时)HBV-DNA水平、肝功能[谷丙转氨酶(ALT)、总胆红素(TBIL)和白蛋白(ALB)]和肝脏弹性[肝脏硬度值(LSM)]及治疗前和治疗24和48周时肝纤维化四项[血清透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)和Ⅲ型前胶原(PC-Ⅲ)];治疗期间(12、24、36和48周)监测肾功能,治疗24和48周时复查肝脏B超,观察不良反应发生情况。结果2组在治疗12、24、36和48周时HBV-DNA水平均显著低于治疗前(均P<0.05);在治疗12周时试验组HBV-DNA水平显著低于对照组(P<0.05),在治疗24、36和48周时2组HBV-DNA水平比较差异无统计学意义(P>0.05)。在治疗12、36和48周时2组HBV-DNA转阴率比较差异无统计学意义(P>0.05);在治疗24周时试验组HBV-DNA转阴率显著高于对照组(P<0.01)。2组在治疗12、24、36和48周时ALT、TBIL和ALB水平均显著低于治疗前(均P<0.05);在治疗12周时试验组ALT、TBIL和ALB水平显著低于对照组(均P<0.05),在治疗24、36和48周时2组ALT、TBIL和ALB水平差异无统计学意义(P>0.05)。在治疗12、24、36、48周时,2组LSM水平均显著低于治疗前,且试验组均显著低于对照组(均P<0.05)。在治疗24和48周时,2组HA、LN、PC-Ⅲ和Ⅳ-C水平均显著低于治疗前,且试验组均显著低于对照组(均P<0.05)。结论替诺福韦酯联合鳖甲煎丸治疗慢性乙肝肝纤维化患者,能够在较短时期内更好地起到抗病毒和恢复肝脏功能的效果,能够使患者的肝脏纤维化水平得到有效控制,在治疗纤维化方面具有优势。

Objective To study the clinical effect of tenofovir dipivoxil fumarate combined with Biejiajian pills on liver fibrosis in patients with chronic hepatitis B.Methods Data of 80 chronic hepatitis B patients with liver fibrosis were analyzed retrospectively.These patients were treated with tenofovir disoproxil fumarate tablets alone(control group,n=40)or in combination with Biejiajian pills(experimental group,n=40).The levels of HBV-DNA,alanine transferase(ALT),total bilirubin(TBIL)and albumin(ALB)and the elasticity of liver were measured and renal function was monitored after treatment for 12,24,36 and 48 weeks.Furthermore,serum hyaluronic acid(HA),laminin(LN),typeⅣcollagen(Ⅳ-C)and typeⅢprocollagen(PC-Ⅲ)levels were determined before and after treatment for 24 and 48 weeks.Moreover,B-mode ultrasound examination was performed at 24 and 48 weeks of treatment to observe the adverse reactions.Results The levels of HBV-DNA,ALT,TBIL,ALB and LSM significantly decreased after treatment for 12,24,36 and 48 weeks in both groups(P<0.05).At 12 weeks of treatment,the levels of HBV-DNA,ALT,TBIL and ALB in the experimental group were lower than those in the control group(P<0.05).However,the differences in HBV-DNA,ALT,TBIL and ALB levels were not significant between the two groups at 24,36 and 48 weeks of treatment(P>0.05).The negative conversion rate of HBV-DNA in the experimental group was higher than that in the control group at 24 weeks of treatment(P<0.01);however,the differences in the negative conversion rate of HBV-DNA were not significant between the two groups at 12,36 and 48 weeks of treatment(P>0.05).The levels of LSM in the experimental group were lower than those in the control group at all time points(P<0.05).At 24 and 48 weeks of treatment,the levels of HA,LN,PC-ⅢandⅣ-C decreased in both groups,and those in the experimental group were lower than those in the control group(P<0.05).Conclusion Tenofovir dipivoxil fumarate combined with Biejiajian pills can protect against hepatitis B virus infection,restore liver function and relieve liver fibrosis in a short period of time in chronic hepatitis B patients with liver fibrosis.