甲泼尼龙联合恩替卡韦治疗乙型肝炎早期肝衰竭的临床效果

Clinical effect of methylprednisolone combined with entecavir in the treatment of early liver failure of hepatitis B

目的探讨甲泼尼龙联合恩替卡韦治疗乙型肝炎早期肝衰竭的临床效果,以为临床治疗药物的合理选择提供参考。方法选取2018年1月1日至2020年12月31日宝鸡市中心医院收治的60例乙型肝炎早期肝衰竭患者作为研究对象,根据随机数字表法将其分为对照组和观察组,各30例。对照组采用恩替卡韦治疗,观察组在对照组基础上联合甲泼尼龙治疗。比较两组的临床疗效、肝功能指标、炎症因子水平及不良反应发生情况。结果观察组的治疗总有效率为93.33%,高于对照组的70.00%,差异具有统计学意义(P<0.05)。治疗前,两组的谷丙转氨酶(ALT)、谷草转氨酶(AST)、直接胆红素(DBIL)、总胆红素(TBIL)水平比较,差异无统计学意义(P>0.05);治疗后,两组的ALT、AST、DBIL、TBIL水平均较治疗前降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。治疗前,两组的单核细胞趋化蛋白-1(MCP-1)、白细胞介素-1β(IL-1β)、高迁移率族蛋白B1(HMGB1)水平比较,差异无统计学意义(P>0.05);治疗后,两组的MCP-1、IL-1β、HMGB1水平均较治疗前降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论甲泼尼龙联合恩替卡韦治疗乙型肝炎早期肝衰竭的效果显著,可改善患者的肝功能指标,降低炎症因子水平,且不增加不良反应,值得临床推广和应用。

Objective To investigate the clinical effect of methylprednisolone combined with entecavir in the treatment of early liver failure of hepatitis B,and to provide reference for the rational selection of clinical drugs.Methods From January 1,2018 to December 31,2020,60 patients with early liver failure of hepatitis B admitted in Baoji Central Hospital were selected as the research objects,and the patients were divided into control group and observation group according to random number table method,with 30 cases in each group.The control group was treated with entecavir,and the observation group was treated with methylprednisolone on the basis of the control group.The clinical efficacy,liver function indexes,inflammatory factors levels and occurrence of adverse reactions of the two groups were compared.Results The total effective rate of treatment in the observation group was 93.33%,which was higher than 70.00%in the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBIL)and total bilirubin(TBIL)between the two groups(P>0.05);after treatment,the levels of ALT,AST,DBIL and TBIL in the two groups were lower than those before treatment,and those in the observation group were lower than the control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in the levels of monocyte chemoattractant protein-1(MCP-1),interleukin-1β(IL-1β)and high mobility group protein B1(HMGB1)between the two groups(P>0.05);after treatment,the levels of MCP-1,IL-1βand HMGB1 in the two groups were lower than those before treatment,and those in the observation group were lower than the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Methylprednisolone combined with entecavir in the treatment of early liver failure of hepatitis B has a significant effect,it can improve the liver function indexes of patients,reduce the levels of inflammatory factors,and do not increase adverse reactions,which is worthy of clinical promotion and application.