双歧杆菌三联活菌联合恩替卡韦治疗慢性乙型肝炎合并非酒精性脂肪性肝炎的效果观察

Observation on effect of bifid-triple viable capsule combined with entecavir in treatment of chronic hepatitis B complicated with nonalcoholic steatohepatitis

目的探讨双歧杆菌三联活菌联合恩替卡韦治疗慢性乙型肝炎(CHB)合并非酒精性脂肪性肝炎(NAFLD)的临床疗效。方法2020年6月—2022年6月驻马店市中心医院消化内科收治的102例CHB合并NAFLD患者根据治疗方法分为常规组和观察组,每组51例;常规组患者采用恩替卡韦治疗,观察组患者在常规组基础上联合双歧杆菌三联活菌治疗,均连续治疗6个月。观察比较两组患者的肝功能[谷氨酰转肽酶(GGT)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]、血脂[总胆固醇(TC)、甘油三酯(TG)]、天门冬氨酸氨基转移酶与血小板比值(APRI)、肝脏受控衰减参数(CAP)、肝脏硬度(LSM)、免疫功能[辅助T淋巴细胞(CD4^(+))和毒性T淋巴细胞(CD8^(+))的表达]和血清HBV-DNA、活性氧(ROS)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)水平。结果治疗后两组患者HBV DNA转阴率和血清HBV DNA水平差异均无统计学意义(P>0.05),但两组患者GGT、AST、ALT、TC、TG、CAP、APRI、LSM、CD8^(+)水平和血清ROS、TNF-α和TGF-β1水平均显著低于治疗前,CD4^(+)和CD4^(+)/CD8^(+)水平显著高于治疗前,且观察组变化幅度显著大于常规组(P<0.05)。结论双歧杆菌三联活菌联合恩替卡韦治疗可改善CHB合并NAFLD患者的肝功能、脂质代谢和肝纤维化程度,降低ROS、TNF-α、TGF-β1水平。

Objective To investigate the clinical efficacy of bifid-triple viable capsule combined with entecavir in the treatment of chronic hepatitis B(CHB)with nonalcoholic steatohepatitis(NAFLD).Methods From June 2020 to June 2022,102 patients with CHB complicated with NAFLD admitted to the Department of Gastroenterology of Zhumadian Central Hospital were divided into routine group and observation group according to the treatment method,with 51 patients in each group.The patients in the routine group were treated with entecavir,and the patients in the observation group were treated with bifid-triple viable capsule on the basis of the routine group,all of which were continuously treated for 6 months.The liver function[glutamyltranspeptidase(GGT),aspartate aminotransferase(AST),alanine aminotransferase(ALT)],blood lipids[total cholesterol(TC),triglyceride(TG)],aspartate aminotransferase to platelet ratio(APRI),liver controlled attenuation parameter(CAP),liver hardness(LSM),immune function[expression of helper T lymphocytes(CD4^(+))and toxic T lymphocytes(CD8^(+))]and serum HBV-DNA,ROS,TNF-α、TGF-β1 level of the two groups were observed and compared.Results After treatment,there were no significant differences in HBV DNA negative rate and serum HBV DNA level between two groups(P>0.05),but the levels of GGT,AST,ALT,TC,TG,CAP,APRI,LSM,CD8^(+)and serum ROS,TNF-αand TGF-β1 were significantly lower than before treatment,the levels of CD4^(+)and CD4^(+)/CD8^(+)were significantly higher than those before treatment,and the change range of observation group was significantly higher than that of routine group(P<0.05).Conclusion Bifid-triple viable capsule combined with entecavir can improve liver function,lipid metabolism and liver fibrosis degree in patients with CHB and NAFLD,and reduce ROS,TNF-αand TGF-β1 levels.