多烯磷脂酰胆碱联合替诺福韦治疗慢性乙型肝炎肝硬化患者的效果

Effects of Polyene phosphatidylcholine combined with Tenofovir in treatment of patients with chronic hepatitis B cirrhosis

目的:观察多烯磷脂酰胆碱联合替诺福韦治疗慢性乙型肝炎(乙肝)肝硬化患者的效果。方法:选取2021年2月至2023年2月该院收治的95例慢性乙肝肝硬化患者进行前瞻性研究,按照随机数字表法将其分为对照组(n=47)和观察组(n=48)。对照组予以富马酸替诺福韦二吡呋酯片治疗,观察组在对照组基础上联合多烯磷脂酰胆碱胶囊治疗,两组均治疗3个月。比较两组乙肝病毒(HBV)-DNA转阴率,治疗前和治疗3个月后肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)]水平、肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)]水平、T细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平,以及不良反应发生率。结果:治疗2、3个月,观察组HBV-DNA转阴率均高于对照组,差异有统计学意义(P<0.05);治疗后,两组ALT、AST、TBIL、HA、LN、Ⅳ-C、PCⅢ水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于治疗前,且观察组高于对照组,两组CD8^(+)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:多烯磷脂酰胆碱联合替诺福韦治疗慢性乙肝肝硬化患者可提高HBV-DNA转阴率,降低肝功能指标和肝纤维化指标水平,改善T细胞亚群指标水平,效果优于单纯替诺福韦治疗。

Objective:To observe effects of Polyene phosphatidylcholine combined with Tenofovir in treatment of patients with chronic hepatitis B cirrhosis.Methods:A prospective study was conducted on 95 patients with chronic hepatitis B cirrhosis admitted to this hospital from February 2021 to February 2023.According to the random number table method,they were divided into control group(n=47)and observation group(n=48).The control group was treated with Tenofovir disoproxil fumarate tablets,while the observation group was treated with Polyene phosphatidylcholine capsules on the basis of that of the control group.Both groups were treated for 3 months.The negative rate of hepatitis B virus(HBV)-DNA,the levels of liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)],the liver fibrosis indexes[hyaluronic acid(HA),laminin(LN),type IV collagen(IV-C),type III procollagen(PCIII)]and the T cell subsets indexes(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),and the incidence of adverse reactions were compared between the two groups before and 3 months after the treatment.Results:After 2 and 3 months of treatment,the negative conversion rates of HBV-DNA in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).After the treatment,the levels of ALT,AST,TBIL,HA,LN,IV-C and PCIII in the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After the treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were higher than those before the treatment,and those in the observation group were higher than those in the control group;the levels of CD8^(+)in the two groups were lower than those before the treatment,and that in the observation group was lower than that in the control group;and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Polyene phosphatidylcholine combined with Tenofovir in the treatment of the patients with chronic hepatitis B cirrhosis can increase the negative rate of HBVDNA,reduce the levels of liver function indexes and liver fibrosis indexes,and improve the levels of T cell subsets indexes.Moreover,it is superior to single Tenofovir treatment.