恩替卡韦与替诺福韦治疗乙型肝炎肝衰竭的临床效果分析

Analysis of clinical effects of entecavir and tenofovir in hepatitis B-related liver failure

目的探讨恩替卡韦(ETV)与替诺福韦(TDF)治疗乙型肝炎肝衰竭的临床效果。方法92例乙型肝炎肝衰竭患者,随机分为观察组(50例)与对照组(42例)。对照组在常规治疗基础上联合恩替卡韦治疗,观察组在对照组基础上联合替诺福韦治疗。对比两组患者治疗前后肝功能指标[总胆红素(TBIL)与谷丙转氨酶(ALT)]、终末期肝病评估模型(MELD)评分及治疗后乙型肝炎病毒的脱氧核糖核酸(HBV-DNA)阴性率。结果治疗后,两组患者TBIL、ALT均较本组治疗前降低,且观察组患者TBIL(70.4±22.6)μmol/L、ALT(64.5±34.5)U/L低于对照组的(114.7±31.6)μmol/L、(127.6±54.4)U/L,差异有统计学意义(P<0.05)。治疗后,两组患者MELD评分均较本组治疗前降低,且观察组患者MELD评分(9.8±1.4)分低于对照组的(12.2±1.5)分,差异有统计学意义(P<0.05)。观察组患者治疗后HBV-DNA阴性率92.0%(46/50)高于对照组的76.2%(32/42),差异有统计学意义(P<0.05)。结论恩替卡韦与替诺福韦均可改善乙型肝炎肝衰竭患者的肝脏功能,抑制肝炎病毒复制,联合应用对于TBIL、ALT等肝功能指标改善更加显著,患者肝功能评分也显著降低。

Objective To discuss the clinical effects of entecavir(ETV)and tenofovir(TDF)in hepatitis B-related liver failure.Methods A total of 92 patients with hepatitis B-related liver failure were randomly divided into observation group(50 cases)and control group(42 cases).The control group was treated with entecavir on the basis of conventional treatment,and the observation group was treated with tenofovir on the basis of the control group.Both groups were compared in terms of liver function indexes[total bilirubin(TBIL)and alanine aminotransferase(ALT)],model for end-stage liver disease(MELD)scores before and after treatment,and hepatitis B virus deoxyribonucleic acid(HBV-DNA)after treatment.Results After treatment,the TBIL and ALT of the two groups were lower than those of this group before treatment;the TBIL(70.4±22.6)μmol/L and ALT(64.5±34.5)U/L of the observation group were lower than(114.7±31.6)μmol/L and(127.6±54.4)U/L of the control group;all the differences were statistically significant(P<0.05).After treatment,the MELD scores of the two groups were lower than those of this group before treatment,and the MELD score(9.8±1.4)points of the observation group was lower than(12.2±1.5)points of the control group,and the difference was statistically significant(P<0.05).After treatment,the negative rate of HBV-DNA 92.0%(46/50)of the observation group was higher than 76.2%(32/42)of the control group,and the difference was statistically significant(P<0.05).Conclusion Both entecavir and tenofovir can improve the liver function and inhibited hepatitis B virus replication in patients with hepatitis B-related liver failure,and the combined application can significantly improve liver function indexes such as TBIL and ALT,and reduce patients’liver function scores.