缬沙坦综合治疗慢性乙型肝炎和肝硬化的临床研究

Therapeutic effect of valsartan on chronic type B hepatitis and liver cirrhosis

目的:观察缬沙坦对慢性乙型肝炎(简称慢肝)和肝硬化患者的临床治疗效果,并探讨其作用机制. 方法:慢肝和肝硬化患者共54例分为对照组与治疗组,每组各27例.对照组给予常规治疗,治疗组在常规治疗的基础上加用缬沙坦80 mg/d,疗程1 mo.两组患者于治疗前后抽血测肝功能、血清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)等以了解治疗前后肝功能、肝纤维化指标的变化.治疗组中有5例患者于治疗前后行肝穿刺对照检查. 结果:两组患者治疗后ALT,AST,r-GT,AKP,TBIL 以及血清肝纤维化指标HA,Ⅳ-C均较治疗前明显好转(P<0.05或0.01).治疗组经缬沙坦治疗后,与治疗前相比,ALT(5.7±1.9 ukat/L vs 1.3+0.7 ukat/L),AST(5.1±1.9 ukat/L vs 1.5+0.7 ukat/L),HA(298+107 ug/L vs 159+92 ug/L),Ⅳ-C(102±24 ug/L vs 63+19 ug/L)等指标明显降低(P<0.05或0.01,2.241≤t≤3.249),与对照组相比,在慢性肝炎患者,上述指标改善更为明显(P<0.05或0.01,2.324≤t≤3.012).经缬沙坦治疗后,肝脏微循环改善,肝细胞炎性浸润程度减轻,纤维化程度分级降低,肝组织G-S分期与治疗前相比有一定程度的好转. 结论:缬沙坦综合治疗慢肝、肝硬化患者能够发挥一定的保护肝细胞,改善肝微循环,逆转肝纤维化的作用.

AIM: To study the clinical effect of valsartan on chronic type B hepatitis and liver cirrhosis. METHODS: A total of 54 patients with chronic type B hepatitis and liver cirrhosis were divided into therapy group and control group, and each group had 27 cases. The patients in the control group were treated with routine treatment, and those in the therapy group, besides routine treatment, were added with valsartan 80 mg/day, and the therapeutic period was one month. Before and after treatment, serum HA, LN, PCIII, IV-C were measured by radio-immunoassay in each group. The parameters of ALT, AST, TBIL, Alb, r-GT and AKP were obtained. In the therapy group, five patients' liver tissues were obtained by liver biopsy, and then stained by H-E staining before and after treatment. RESULTS: In these two groups, the parameters of ALT, AST, r-GT, AKP , TBIL, HA, and IV-C were all improved remarkably (P<0.05 or 0.01) after treatment. In the therapy group, the parameters of ALT (5.7±1.9 ukat/L vs 1.3±0.7 ukat/L), AST (5.1±1.9 ukat/L vs 1.5±0.7 ukat/L), HA (298±107 ug/L vs 159±92 ug/L) and IV-C (102±24 ug/L vs 63±19 ug/L) were all descended (P<0.05 or 0.01, 2.241≤t≤3.249) before and after treated with valsartan. Compared with control group, especially in chronic hepatitis patients, these parameters were decreased significantly (P<0.05 or 0.01, 2.324≤t≤3.012), the liver microcirculation was improved, the inflammatory infiltration in liver was relieved, the liver tissue fibrosis was degraded, and the liver histology was remarkably improved. CONCLUSION: As valsartan can effectively protect the liver cells, reverse the process of liver fibrosis, it is a feasible choice in the treatment of chronic hepatitis and liver cirrhosis.