富马酸替诺福韦二吡呋酯治疗乙型肝炎肝硬化临床评价

Efficacy Evaluation of Tenofovir Disoproxil Fumarate in the Treatment of Patients with Hepatitis B Cirrhosis

目的探讨富马酸替诺福韦二吡呋酯(TDF)对乙型肝炎(简称乙肝)肝硬化患者乙型肝炎病毒脱氧核糖核酸(HBV-DNA)、乙型肝炎病毒标志物(HBV-M)、淋巴细胞水平的影响。方法选取医院2017年2月至2018年4月收治的乙肝肝硬化患者84例,按随机数字表法分为研究组(给予TDF治疗)和对照组(给予拉米夫定治疗),各42例。两组均持续治疗48周。结果治疗后,研究组患者乙型肝炎病毒e抗原(HBeAg)阴转率及乙型肝炎e抗体(HBeAb)阳转率均明显高于对照组(P<0.05);两组患者的HBV-DNA、CD8+T淋巴细胞、透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(CⅣ)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、白细胞介素9(IL-9)、辅助性T细胞9(Th9)水平均较治疗前明显下降,且研究组明显低于对照组;两组患者CD4+T淋巴细胞水平及CD4+/CD8+均较治疗前明显上升,且研究组明显高于对照组(P<0.05)。治疗过程中,两组患者的药物耐受性均良好,出现血磷轻度下降3例,经对症治疗均恢复正常。结论TDF治疗乙肝肝硬化,能有效改善HBV-M、HBV-DNA及淋巴细胞水平,降低肝纤维化程度及机体炎性水平。

Objective To investigate the effect of tenofovir disoproxil fumarate(TDF)on hepatitis B virus(HBV)-DNA,HBV markers(HBV-M)and lymphocyte levels in patients with hepatitis B cirrhosis.Methods Totally 84 patients with hepatitis B cirrhosis admitted to our hospital from February 2017 to April 2018 were selected and randomly divided into the study group(treated with TDF)and the control group(treated with lamivudine)according to the random number table method,42 cases in each group.Both groups were continuously treated for 48 weeks.Results After treatment,the HBeAg negative conversion rate and HBeAb positive conversion rate in the study group were significantly higher than those in the control group(P<0.05).The levels of HBV-DNA,CD8+T lymphocytes,hyaluronic acid(HA),laminin(LN),typeⅣcollagen(CⅣ),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),IL-9 and Th9 in the two groups were significantly lower than those before treatment,and those in the study group were significantly lower than those in the control group,while the levels of CD4+T lymphocytes and CD4^(+)/CD8^(+)in the two groups were significantly higher than those before treatment,and those in the study group were significantly higher than those in the control group(P<0.05).During the treatment,the drug tolerance of patients in the two groups were good,three cases had a mild decrease of blood phosphorus,and recovered to normal after symptomatic treatment.Conclusion TDF in the treatment of hepatitis B cirrhosis can effectively improve the levels of HBV-M,HBV-DNA and lymphocytes,reduce the degree of liver fibrosis and the levels of inflammation factors.