恩替卡韦治疗失代偿期乙肝肝硬化疗效观察

Efficacy observation of entecavir on decompensated hepatitis B cirrhosis

目的探讨失代偿期乙型病毒性肝炎(乙肝)肝硬化患者应用恩替卡韦治疗的临床疗效。方法68例失代偿期乙肝肝硬化患者,以随机数字表法分为对照组和观察组,每组34例。对照组患者予以阿德福韦酯治疗,观察组患者予以恩替卡韦治疗。比较两组临床疗效,治疗后肝纤维化指标[血清透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、层连蛋白(LN)、Ⅲ型前胶原(PCⅢ)]下降幅度、炎症因子[白介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)]下降幅度,治疗前后肝功能指标[天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、丙氨酸氨基转移酶(ALT)]。结果观察组患者用药总有效率94.12%明显高于对照组的76.47%,差异具有统计学意义(P<0.05)。观察组患者治疗后HA、Ⅳ-C、LN、PCⅢ下降幅度分别为(199.26±15.67)、(65.81±13.29)、(54.65±16.25)、(91.47±10.54)μg/L,均显著大于对照组的(31.99±17.72)、(42.97±14.08)、(31.94±17.73)、(44.86±11.54)μg/L,差异具有统计学意义(P<0.05)。观察组治疗后IL-6、IL-8、TNF-α下降幅度分别为(69.51±8.14)、(0.52±0.09)、(15.67±2.09)ng/L,均显著大于对照组的(49.84±9.46)、(0.27±0.06)、(9.84±2.36)ng/L,差异具有统计学意义(P<0.05)。治疗前,两组患者的AST、TBiL、ALT水平比较,差异无统计学意义(P>0.05);治疗后,两组患者的AST、TBiL、ALT水平均明显低于治疗前,且观察组患者的TBiL(25.74±3.26)μmol/L、AST(50.68±12.66)U/L、ALT(49.47±10.26)U/L均明显低于对照组的(32.55±4.36)μmol/L、(65.81±15.51)U/L、(65.69±15.07)U/L,差异具有统计学意义(P<0.05)。结论恩替卡韦治疗失代偿期乙肝肝硬化,不仅可改善患者肝功能指标,同时有利于控制炎症反应,提高患者预后。

Objective To discuss the clinical efficacy of entecavir on decompensated hepatitis B cirrhosis.Methods A total of 68 patients with decompensated hepatitis B cirrhosis were randomly divided into control group and observation group,with 34 cases in each group.The control group was treated with adefovir dipivoxil,and the observation group was treated with entecavir.Both groups were compared in terms of clinical efficacy,decrease of liver fibrosis indexes[serum hyaluronic acid(HA),typeⅣcollagen(Ⅳ-C),laminin(LN),typeⅢprocollagen(PCⅢ)]and inflammatory factors[interleukin(IL)-6,IL-8,tumor necrosis factor-α(TNF-α)]after treatment,liver function indexes[aspartate aminotransferase(AST),total bilirubin(TBiL),alanine aminotransferase(ALT)]before and after treatment.Results The total effective rate of the observation group was 94.12%,which was significantly higher than that of 76.47%of the control group,and the difference was statistically significant(P<0.05).After treatment,HA,Ⅳ-C,LN and PCⅢdecreased by(199.26±15.67),(65.81±13.29),(54.65±16.25)and(91.47±10.54)μg/L in the observation group,which were significantly higher than those of(31.99±17.72),(42.97±14.08),(31.94±17.73)and(44.86±11.54)μg/L in the control group,and the differences were statistically significant(P<0.05).After treatment,IL-6,IL-8 and TNF-αdecreased by(69.51±8.14),(0.52±0.09)and(15.67±2.09)ng/L in the observation group,which were significantly greater than those of(49.84±9.46),(0.27±0.06)and(9.84±2.36)ng/L in the control group,and the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in AST,TBiL and ALT levels between the two groups(P>0.05).After treatment,the levels of AST,TBiL and ALT in the two groups were significantly lower than those before treatment;the observation group had TBiL of(25.74±3.26)μmol/L,AST of(50.68±12.66)U/L and ALT of(49.47±10.26)U/L,which were significantly lower than those of(32.55±4.36)μmol/L,(65.81±15.51)U/L and(65.69±15.07)U/L in the control group;the differences were statistically significant(P<0.05).Conclusion Entecavir treatment of decompensated hepatitis B cirrhosis can not only improve liver function indicators,but also help control inflammatory responses to improve the prognosis of patients.