拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化失代偿期的效果及对红细胞分布宽度和炎性因子水平的影响

Effectiveness of Lamivudine Combined with Adefovir Dipivoxil in Treatment of Patients with Decompensated Hepatitis B Cirrhosis and Its Effects on Erythrocyte Distribution Width and Levels of Inflammatory Factors

目的探讨拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化失代偿期患者的效果及对红细胞分布宽度(RDW)和炎性因子水平的影响。方法选取2019年7月—2020年2月本院收治的乙型肝炎肝硬化失代偿期患者300例,根据治疗方法的不同均分为观察组和对照组,对照组给予拉米夫定治疗,观察组给予拉米夫定联合阿德福韦酯治疗,均持续治疗3个月。比较2组治疗前后Child-Pugh评分、乙型肝炎e抗原(HBeAg)转阴率、乙型肝炎病毒(HBV)DNA定量、RDW,肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)、凝血酶原活动度(PTA)],肝纤维化指标[透明质酸酶(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)],血清炎性因子[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)]水平,血流动力学指标[门静脉主干内径(PVD)、门静脉血流量(PVQ)、脾静脉内径(SVD)、脾静脉血流量(SVQ)]及不良反应发生率。结果治疗后观察组Child-Pugh评分及HBV DNA、RDW、ALT、AST、TBIL、HA、LN、Ⅳ-C、PCⅢ、IL-1β、TNF-α、PVD、PVQ、SVD、SVQ水平均低于对照组,HBeAg转阴率及ALB、PTA、IL-10水平高于对照组,差异有统计学意义(P<0.05,P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化失代偿期患者的效果较好,可有效抑制HBV复制,改善肝功能,降低RDW和炎性因子水平,且安全性较高。

Objective To investigate the effectiveness of Lamivudine combined with Adefovir Dipivoxil in treatment of patients with decompensated hepatitis B cirrhosis and its effects on erythrocyte distribution width(RDW)and levels of inflammatory factors.Methods A total of 300 patients with decompensated hepatitis B cirrhosis admitted between July 2019 and February 2020 were selected and divided into observation group and control group according to different therapeutic methods.Control group was treated with Lamivudine,while observation group was treated with Lamivudine combined with Adefovir Dipivoxil,and two groups were continuously treated for 3 months.Child-Pugh score,hepatitis B e antigen(HBeAg)negative conversion rate,hepatitis B virus(HBV)DNA quantification,RDW,liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB),prothrombin activity(PTA)]and liver fibrosis indexes[hyaluronidase(HA),Laminin(LN),typeⅣcollagen(Ⅳ-C),typeⅢprocollagen(PCⅢ)],serum inflammatory factors[interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)]levels,hemodynamic indexes[main portal vein diameter(PVD),blood quantities of portal vein(PVQ),splenic vein diameter(SVD),splenic vein blood flow quantities(SVQ)]before and after treatment and the incidence rate of adverse reactions were compared between two groups.Results After treatment in observation group,values of Child-Pugh score,HBV DNA,RDW,ALT,AST,TBIL,HA,LN,Ⅳ-C,PCⅢ,IL-1β,TNF-α,PVD,PVQ,SVD and SVQ levels were significantly lower,while the negative conversion rate of HBeAg and levels of ALB,PTA and IL-10 were significantly higher than those in control group(P<0.05,P<0.01).There was no significant difference in the incidence rate of adverse reactions between two groups(P>0.05).Conclusion Lamivudine combined with Adefovir Dipivoxil in treatment of patients with decompensated hepatitis B cirrhosis may achieve good effectiveness,effectively inhibit HBV virus replication,improve liver function and reduce levels of RDW and inflammatory factors with good safety.