替诺福韦酯对慢性乙型肝炎患者免疫功能及肝功能的影响

Influence of Tenofovir Disoproxil on immune function and liver function in patients with chronic hepatitis B

目的探讨替诺福韦酯治疗对慢性乙型肝炎患者免疫功能及肝功能的影响。方法选取2019年7月至2020年7月在南通市中医院就诊的70例慢性乙型肝炎患者为研究对象,按照治疗方法不同分为对照组(35例)和观察组(35例)。对照组采用恩替卡韦进行治疗,观察组采用替诺福韦酯进行治疗,比较两组患者治疗前及治疗6、12个月后的肝功能情况[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)]水平,治疗3、6、12个月的乙型肝炎病毒基因(HBV-DNA)转阴率,治疗前和治疗12个月后的免疫功能(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))及不良反应发生情况。结果两组治疗前的AST、ALT、TBil水平比较,差异无统计学意义(P>0.05);两组治疗6、12个月后的AST、ALT、TBil水平低于治疗前,差异有统计学意义(P<0.05);观察组治疗6、12个月后的AST、ALT、TBil水平低于对照组,差异有统计学意义(P<0.05)。两组治疗3个月后的HBV-DNA转阴率比较,差异无统计学意义(P>0.05);两组治疗6、12个月后HBV-DNA转阴率均高于治疗前,差异有统计学意义(P<0.05);观察组治疗6、12个月后的HBV-DNA转阴率高于对照组,差异有统计学意义(P<0.05)。两组治疗前的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P>0.05);两组治疗后的CD4^(+)、CD4^(+)/CD8^(+)水平均高于治疗前,CD8^(+)水平低于治疗前,差异有统计学意义(P<0.05);观察组治疗后的CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。观察组的不良反应发生率为17.14%(6/35),与对照组的25.71%(9/35)比较,差异无统计学意义(P>0.05)。结论替诺福韦酯治疗慢性乙型肝炎能够有效改善患者的肝功能,提升HBV-DNA转阴率,进而更有利于肝功能转归,且安全性高。

Objective To investigate the influence of Tenofovir Disoproxil on the immune function and liver function of chronic hepatitis B.Methods A total of 70 patients with chronic hepatitis B who were treated in Nantong Hospital of Traditional Chinese Medicine from July 2019 to July 2020 were selected as research objects,and they were divided into the control group(35 cases)and the observation group(35 cases)according to different treatment methods.The control group was treated with Entecavir,and the observation group was treated with Tenofovir Dipivoxil.The levels of liver function such as aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBil),the negative conversion rates of hepatitis B virus DNA(HBV-DNA)at 3,6,12 months after treatment,the levels of immune function(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before treatment and 12 months after treatment and adverse reactions were compared between the two groups.Results There were no significant difference in the levels of AST,ALT or TBil between the two groups before treatment(P>0.05).The levels of AST,ALT and TBil in the two groups after 6 and 12 months of treatment were lower than those before treatment,the differences were statistically significant(P<0.05).The levels of AST,ALT and TBil in the observation group after 6 and 12 months of treatment were lower than those in the control group,with statistical differences(P<0.05).There was no significant difference in the negative conversion rate of HBV-DNA between the two groups after 3 months of treatment(P>0.05).The negative conversion rates of HBV-DNA after 6 and 12 months of treatment in the two groups were higher than those before treatment,the differences were statistically significant(P<0.05).The negative conversion rates of HBV-DNA in the observation group after 6 and 12 months of treatment were higher than those in the control group,with statistical significances(P<0.05).Before treatment,there were no significant differences in the values of CD4^(+),CD8^(+),or CD4^(+)/CD8^(+)between the two groups(P>0.05).After treatment,the values of CD4^(+)and CD4^(+)/CD8^(+)in the two groups were all higher than those before treatment,the value of CD8^(+)in the two groups after treatment were all higher than those before treatment,the differences were statistically significant(P<0.05).The values of CD4^(+)and CD4^(+)/CD8^(+)of the observation group after treatment were higher than those of the control group,and the CD8^(+)of the observation group after treatmemt was lower than that of the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 17.14%(6/35),and there was no significant difference compared with 25.71%(9/35)in the control group(P>0.05).Conclusion Tenofovir Disoproxil in the treatment of chronic hepatitis B can effectively improve the liver function of patients,increase the negative conversion rate of HBV-DNA,which is more conducive to the prognosis of liver function,and has high safety.