代偿期乙型肝炎肝硬化患者长期抗病毒治疗后临床特点和肝脏组织学改变  

Clinical and histologic improvements in patients with hepatitis B virus-related compensated cirrhosis ;after long-term antiviral treatment

作　　者：应灵军[1] 陈华忠[1] 张建伟[2] 邵辉[1] 程乾刚[1] 刘均艳[1] 汤永志[1] 吴伟梯[1] 

机构地区：[1]浙江省台州医院感染科,浙江临海317000 [2]浙江省台州医院病理科,浙江临海317000

出　　处：《中华临床感染病杂志》2016年第1期13-18,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：台州市科技计划项目（072KY41）

摘　　要：目的：探讨长期抗病毒治疗对代偿期乙型肝炎肝硬化（乙肝肝硬化）患者临床指标和肝脏组织学的影响。方法选择2010年9月至2015年3月于浙江省台州医院接受抗病毒治疗的61例代偿期乙肝肝硬化患者进行前瞻性研究，其中HBeAg阳性26例，HBeAg阴性35例。接受恩替卡韦（ ETV）治疗39例，阿德福韦酯（ ADV）治疗22例。每3个月检测患者生化学、血清学和病毒学指标，根据实验室检查作肝功能CTP（Child-Turcotte-Pugh）评分。所有患者在基线及治疗144周后行肝穿刺活检，采用Metavir评分系统评估患者肝组织炎症活动度（ A）和纤维化分期（ F），治疗前后的比较用配对资料Wilcoxon秩和检验。肝功能治疗前后的比较采用配对t检验。结果61例代偿期乙肝肝硬化患者抗病毒治疗144周后，95．1％（58／61）的患者 HBV DNA载量低于检测值下限，14例（14／26，53．8％）HBeAg阳性患者获得HBeAg消失，10例（10／26，38．5％）获得HBeAg血清学转换。与抗病毒治疗前相比，患者的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和血清总胆红素（TBil）水平降低（t＝7．489、8．259和14．000，P值均＜0．01），凝血酶原时间（PT）缩短（t＝9．777，P＜0．01），血清白蛋白（Alb）水平增加（t＝3．446，P＜0．01），CTP评分降低（t＝6．026，P＜0．01）。抗病毒治疗后，患者肝组织炎症活动度和纤维化分期均得到明显改善（Z＝5．716和6．657，P＜0．01）。26例基线肝组织炎症活动度为A1的患者中，16例降为A0；24例基线为A2的患者中，9例降为A0，15例降为A1；11例基线为A3的患者中，1例降为A0，5例降为A1，5例降为A2。61例患者基线肝组织纤维化分期均为F4，治疗后7例降为F1期，22例降为F2期，20例降为F3期。结论代偿期乙肝肝硬化患者经过长期抗病毒治疗后临床指标和肝脏组织学均能得到改善。Objective To investigate the effect of long-term antiviral treatment on clinical outcome and liver histology in patients with hepatitis B virus （ HBV）-related compensated cirrhosis .Methods A total of 61 patients with HBV-related compensated cirrhosis receiving antiviral therapy were enrolled from Taizhou Hospital of Zhejiang Province during September 2010 and March 2015, including 26 HBeAg-positive cases and 35 HBeAg-negative cases .Thirty-nine patients were treated with entecavir （ ETV ） and 22 were treated with adefovir dipivoxil （ ADV ） .Biochemical , serological and virological markers were examined＆amp;nbsp;every 3 months during treatment, and Child-Turcotte-Pugh （CTP） scores were calculated.All the patients underwent liver biopsy before and 144 weeks after antiviral treatment .Metavir scoring system was used to evaluate the liver histological activity （ A） and fibrosis score （ F） .Wilcoxon rank sum test and paired t-test were used for the evaluation of liver histopathology and liver function before and after treatment , respectively.Results After 144 weeks of antiviral treatment , HBV DNA was reduced and below the lower limit of detection in 58 patients （95.1%）, HBeAg disappeared in 14 patients （14/26, 53.8%）, and HBeAg seroconversion was observed in 10 patients （10/26, 38.5%）; alanine aminotransferase （ ALT）, aspartate amino transaminase （AST）, total bilirubin （TBil） and CTP score decreased （t=7.489, 8.259, 14.000 and 6.026, all P〈0.01）, prothrombin time （PT） was shortened （t=9.777, P〈0.01）, and serum albumin （Alb） increased （t=3.446, P〈0.01）.Improvements in both liver histologic activity and fibrosis score were observed （Z=5.716 and 6.657, all P〈0.01）.Liver histological activity decreased from A1 to A0 in 16 cases, from A2 to A0 in 9 cases, from A2 to A1 in 15 cases, from A3 to A0 in 1 case, from A3 to A1 in 5 cases, and from A3 to A2 in 5 cases.Fibrosis score at the baseline was F 4 for all patients, while after treatment,

关 键 词：肝炎 乙型 慢性 肝硬化 抗病毒药 活组织检查 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]