恩替卡韦联合阿德福韦酯治疗乙型病毒性肝炎肝硬化的疗效与安全性评价

Curative effect and safety ofentecavir combined with adefovirdipivoxil on hepatitis B cirrhosis

目的探讨恩替卡韦(ETV)联合阿德福韦酯(ADV)治疗乙型病毒性肝炎(乙肝)肝硬化的疗效及安全性.方法选取我院2018年1月~2019年1月收治的134例乙肝肝硬化患者,按照随机数字表法分为观察组和对照组,各67例.对照组使用单一ETV治疗,观察组在对照组的基础上联合使用ADV治疗,均连续治疗48周.比较两组肝功能指标、不同时间段内血清病毒学(HBV)标志物及HBV-DNA定量变化、不良反应的发生率.结果两组治疗后血清ALT、AST、TBil、ALP水平明显降低,ALP水平明显升高,且观察组各指标升高或降低的幅度显著高于对照组(P<0.05);两组治疗后第8周、16周、32周的HBeAg转阴率、HBV-DNA转阴率比较差异无统计学意义(P>0.05);但观察组治疗后第48周的HBeAg转阴率及HBV-DNA转阴率均显著高于对照组(P<0.05);观察组不良反应发生率为10.45%,与对照组的4.48%相比,差异无统计学意义(P>0.05).结论ETV联合ADV治疗乙肝肝硬化可明显改善患者的肝功能,抑制乙肝病毒HBV复制,延缓疾病进展,且治疗期间未发生严重不良反应,安全性较高,值得临床推广应用.

Objective To explore the curative effect and safety of entecavir(ETV)combined with adefovir dipivoxil(ADV)on virus B hepatitis(hepatitis B)cirrhosis.Methods A total of 134 patients with hepatitis B cirrhosis who were admitted to the hospital from January 2018 to January 2019 were enrolled.They were divided into observation group and control group by random number table method,67 cases in each group.The control group was treated with ETV,while observation group was treated with ETV combined with ADV.All were treated for 48 weeks continuously.The liver function indexes,quantitative changes in serum virology(HBV)markers and HBV-DNA,and incidence of adverse reartions were compared between the two groups.Results After treatment,levels of senjm ALT,AST,TBil and ALP were significantly decreased,while ALB level was significantly increased in both groups.The increase or decrease amplitude of each index in observation group was significantly higher than that in control group(P<0.05).At 8 weeks,16 weeks and 32 weeks after treatment,there were no significant differences in negative conversion rates of HBeAg and HBV-DNA between the two groups(P>O.05).At 48 weeks after treatment,negative conversion rates of HBeAg and HBV-DNA in observation group were significantly higher than those in control group(P<0.05).There were no significant rlifferenres in incidence of adverse reactions between observation group and control group(10.45%vs 4.48%)(P>O.05).Conclusion ETV combined with ADV in the treatment of hepatitis B cirrhosis can significantly improve liver function of patients,inhibit the replication of HBV and delay disease progression,without severe adverse reartions during treatment and with high safety.