阿德福韦对慢性乙型病毒性肝炎患者血浆细胞因子及肝纤维化指标的影响  

The Effect of Adefovir on the Plasma Level of Cytokine and Hepatic Fibrosis Index in Patients with Chronic Hepatitis B

作　　者：钟水清[1] 楼克忻 

机构地区：[1]浙江省丽水市松阳县人民医院感染科,323400

出　　处：《中国全科医学》2010年第36期4074-4076,共3页Chinese General Practice

摘　　要：目的探讨阿德福韦对慢性乙型病毒性肝炎(乙肝)患者血浆细胞因子及肝纤维化指标的影响。方法选取68例轻中度慢性乙肝患者,将其随机分为阿德福韦组和对照组,各34例。对照组给予常规保肝治疗,阿德福韦组在对照组常规保肝治疗的基础上加用阿德福韦酯(10 mg,1次/d)治疗6个月。分别在治疗前和治疗6个月后检测两组患者的肝功能〔丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)〕、血浆细胞因子〔转化生长因子β1(TGF-β1)、肿瘤坏死因子α(TNF-α)、肝细胞生长因子(HGF)〕和肝纤维化指标〔透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(ⅣC)、层粘蛋白(LN)〕的变化。结果两组患者治疗前肝功能、血浆细胞因子水平及肝纤维化指标间差异无统计学意义(P>0.05);而治疗后两组患者ALT、AST、TGF-β1、TNF-α、HA、PCⅢ、ⅣC、LN水平均较治疗前显著下降,HGF水平较治疗前显著升高,差异均有统计学意义(P<0.05);且治疗后两组患者上述指标比较,差异亦有统计学意义(P<0.05)。结论阿德福韦能促进HGF的表达,减少肝组织中TGF-β1、TNF-α分泌,进而抑制肝星状细胞活化和细胞外基质的合成,促进其分解,从而起到抗肝纤维化和减轻肝组织炎症的作用。Objective To explore the effect of adefovir on the plasma level of cytokine and hepatic fibrosis index in patients with chronic hepatitis B.Methods 68 patients with slight or moderate chronic hepatitis B were randomly divided into treatment group and control group,with each group 34 patients.The control group received routine hepatoprotection treatment,while the treatment group got extra treatment of taking adefovir 10 mg one time a day,the treatment lasted for 6 months.Detect the level of liver function as ALT,AST,TGF-β1,TNF-α and HGF and the fibrosis index as HA,PC Ⅲ,Ⅳ C and LN before treatment and after treatment.Results There were no statistical differences between the two groups on liver function,plasma cytokine and liver fibrosis index before treatment（P〉0.05）.But after treatment,the ALT,AST,TGF-β1,TNF-α,HA,PC Ⅲ,Ⅳ C and LN reduced significantly and HGF increased significantly compared with the level before treatment in both of the two groups（P〈0.05）.And there were also statistical difference between the two groups on the above-mentioned indexes after treatment（P〈0.05）.Conclusion Adefovir can up-regulate the expression of HGF,down-regulate the secretion of TGF-β1 and TNF-α in the hepatic tissue,and thus can suppress the activation of hepatic stellate cell and synthesis of the extracellular matrix,promote its decomposition,by which it plays an important role in anti-hepatic fibrosis and anti-inflammation of hepatic tissues.

关 键 词：阿德福韦 肝炎 乙型 慢性 肝硬化 转化生长因子Β1 肿瘤坏死因子α 肝细胞生长因子 

分 类 号：R512.62[医药卫生—内科学]