肝宁片联合替诺福韦酯对甲胎蛋白升高慢性乙型病毒性肝炎患者血清AFP水平、APRI评分及肝纤维化程度的影响

The effects of Ganning Tablet combined with tenofovir disoproxil on the levels of AFP, APRI score and the degree of liver fibrosis in chronic hepatitis B patients with elevated AFP

目的:探究肝宁片联合替诺福韦脂对甲胎蛋白(AFP)升高慢性乙型肝炎患者血清AFP水平、天门冬氨酸氨基转移酶(AST)和血小板比率指数(APRI)评分及肝纤维化程度的影响。方法:选取2018年9月至2019年10月门诊收治的108例AFP升高慢性乙型肝炎患者,按随机数字表法分为观察组和对照组,每组54例。对照组患者给予替诺福韦酯口服,观察组患者在前者基础上加用肝宁片治疗。抽取空腹血检测并比较两组患者治疗后乙型肝炎病毒DNA(HBV DNA)转阴率、治疗前后血清AST、血清丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、AFP水平、肝纤维化程度、患者满意度以及不良反应发生率。结果:经治疗后观察组患者转氨酶复常、HBV DNA转阴率均明显高于对照组(P<0.05)。血清AFP、AST、ALT及TBil水平较治疗前均明显降低(P<0.05),且观察组患者明显低于对照组(P<0.05)。两组患者APRI评分、血清HA、IV-C、FIB-4指数等各项水平较治疗前均明显降低(P<0.05),且观察组患者明显低于对照组(P<0.05)。观察组患者经治疗后满意度明显高于对照组(P<0.05)。观察组患者不良反应发生率明显低于对照组患者(7.41%vs 24.07%,P<0.05)。结论:肝宁片联合替诺福韦酯可有效降低AFP升高慢性乙型肝炎患者血清AFP水平及APRI评分,改善肝功能及肝纤维化程度,降低不良反应发生率,患者接受度较高,安全有效。

Objective:To investigate the effects of Ganning Tablet combined with tenofovir disoproxil on the levels of alpha fetoprotein(AFP), aspartate aminotransferase(AST) to platelet ratio index(APRI) score and the degree of liver fibrosis in chronic hepatitis B patients with elevated AFP.Methods:A total of 108 patients with chronic hepatitis B with elevated AFP from September 2018 to October 2019 were randomly divided into observation group and control group according to random number table method, with 54 cases in each group. The control group was given tenofovir dipivoxil orally, and the observation group was treated with Ganning Tablet on the basis of the former. The fasting blood samples were collected for detection, and the negative rate of HBV DNA after treatment, the levels of AST, alanine aminotransferase(ALT), total bilirubin(TBil), AFP, and the degree of liver fibrosis(the effects on the degree of liver fibrosis were evaluated by serum hyaluronic acid, type Ⅳ collagen, APRI and FIB-4 score) before and after treatment, the patients’ satisfaction and incidence of adverse reactions were compared between the two groups. Results:Transaminase normalization and HBV DNA negative rate in the observation group were significantly higher than those in the control group(P<0.05). The levels of serum AFP, AST, ALT and TBil were significantly lower than those before treatment( P < 0. 05),and the observation group were significantly lower than the control group( P < 0. 05). The APRI score,levels of serum HA,Ⅳ-C and FIB-4 in the two groups were significantly lower than those before treatment( P < 0. 05),and the observation group were significantly lower than the control group( P < 0. 05). The patients’ satisfaction in the observation group was significantly higher than that in the control group( P < 0. 05). The incidence of adverse reactions in the observation group was lower than in the control group( 7. 41% vs 24. 07% P < 0. 05). Conclusion: Ganning Tablet combined with tenofovir dipivoxil in the treatment of chronic hepatitis B patients with elevated AFP is effective in reducing AFP level and APRI score,improving liver function and liver fibrosis degree,reducing the incidence of adverse reactions,the patients’ acceptance is high,and this method is safe and effective.