恩替卡韦联合前列地尔治疗乙肝肝硬化伴肝源性糖尿病39例

Clinical Study of Entecavir Combined with Alprostadil in the Treatment of 39 Cases of Hepatitis B Cirrhosis with Hepatogenic Diabetes

目的:探讨乙肝肝硬化伴肝源性糖尿病采用恩替卡韦联合前列地尔治疗的应用效果。方法:选取新乡市传染病医院2019年1月至2020年12月78例乙肝肝硬化伴肝源性糖尿病患者,两组均进行常规治疗,将给予恩替卡韦治疗的39例作为对照组,将给予恩替卡韦联合前列地尔治疗的39例作为观察组。比较治疗前后两组肝功能指标[丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)],血糖水平指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)],肝纤维化指标[层粘连蛋白(LA)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)],治疗效果及不良反应发生率。结果:AST、ALT、FPG、2 h PG水平两组治疗前差异无统计学意义(P>0.05),两组治疗后水平均下降;且观察组ALT、AST水平为(30.23±9.66)U/L、(32.88±9.24)U/L明显低于对照组的(39.78±8.35)U/L、(41.26±10.38)U/L(均P<0.05),观察组FPG、2 h PG水平为(5.53±0.67)mmol/L、(7.86±0.74)mmol/L,明显低于对照组的(6.79±0.59)mmol/L、(8.36±0.88)mmol/L(均P<0.05)。两组治疗前HA、PCⅢ、LA水平差异无统计学意义(P>0.05),治疗后观察组的HA、PCⅢ、LA水平为(152.26±30.64)ng/mL、(124.35±39.65)μg/L、(122.59±19.52)ng/mL,明显低于对照组的(179.36±38.74)ng/mL、(153.37±42.15)μg/L、(153.77±20.47)ng/mL(P<0.05)。治疗后观察组总有效率92.31%,明显高于对照组71.79%(P<0.05)。不良反应发生率两组差异无统计学意义(P>0.05)。结论:前列地尔联合恩替卡韦治疗乙肝肝硬化伴肝源性糖尿病患者能进一步改善患者血糖、肝纤维化、肝功能,且不增加不良反应。

Objective:To investigate the effect of entecavir combined with alprostadil in the treatment of hepatitis B cirrhosis with hepatogenic diabetes mellitus.Methods:A total of 78 patients with hepatitis B cirrhosis and hepatogenic diabetes mellitus were selected from Xinxiang Infectious Disease Hospital from January 2019 to December 2020.Both groups received conventional treatment.39 patients receiving entecavir treatment were selected as the control group,and 39 patients receiving alprostadil treatment on the basis of the control group were selected as the observation group.Compare two groups before and after the treatment of liver function index[alanine aminotransferase(ALT),nmda aminotransferase(AST)],blood glucose level index[fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG)],liver fibrosis index[laminin(LA),hyaluronic acid(HA),collagen type Ⅲ(PCⅢ)],therapeutic effect and adverse reaction rate.Results:There was no significant difference in AST and ALT levels between the two groups before treatment(P>0.05),after treatment,the levels of ALT and AST in the observation group were(30.23±9.66)U/L and(32.88±9.24)U/L,which were significantly lower than those in the control group(39.78±8.35)U/L and(41.26±10.38)U/L,and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in FPG and 2 h PG levels between the two groups(P>0.05).After treatment,the levels of FPG and 2 h PG in the observation group were(5.53±0.67)mmol/L and(7.86±0.74)mmol/L,which were significantly lower than those in the control group(6.79±0.59)mmol/L and(8.36±0.88)mmol/L.The difference was statistically significant(P<0.05).Before treatment,there were no significant differences in HA,PCⅢ and LA between the two groups(P>0.05),after treatment,the levels of HA,PCⅢ and LA in the observation group were(152.26±30.64)ng/mL,(124.35±39.65)μg/L,(122.59±19.52)ng/mL.Significantly lower than that of control group(179.36±38.74)ng/mL,(153.37±42.15)μg/L,(153.77±20.47)ng/mL(P<0.05).After treatment,the total effective rate of observation group was 92.31%,which was significantly higher than that of control group(71.79%)(P<0.05).The incidence of adverse reactions was 7.69% in the observation group and 5.13% in the control group,with no statistical significance(P>0.05).Conclusion:Alprostol combined with entecavir can further improve blood glucose,liver fibrosis and liver function in patients with hepatitis B cirrhosis and hepatogenic diabetes mellitus without increasing adverse reactions.