恩替卡韦治疗血清HBV DNA阴性乙型肝炎肝硬化的疗效  

Prognosis of entecavir treatment for serum HBV DNA negative hepatitis B cirrhosis

作　　者：叶志典 莫思柏 洪永孟 罗贤鑫 

机构地区：[1]广东省阳江市公共卫生医院感染内科,广东阳江529500

出　　处：《热带医学杂志》2016年第10期1310-1312,1323,共4页Journal of Tropical Medicine

摘　　要：目的观察恩替卡韦治疗血清HBV DNA阴性乙型肝炎肝硬化对预后的影响。方法将76例血清HBV DNA阴性乙型肝炎肝硬化(代偿期)患者随机分为两组,对照组36例,给予护肝、抗肝纤维化及对症等治疗;治疗组40例,在对照组治疗基础上给予恩替卡韦0.5 mg/d,疗程均为12个月。观察并记录两组患者的肝肾功能、凝血酶原时间(PT)、肝纤扫描肝脏硬度值、Child-Pugh评分及药物不良反应情况。结果在治疗6、12个月时,治疗组生化指标改善较对照组明显,两组患者同期比较差异均有统计学意义(P<0.05)。两组患者肝纤扫描检查提示肝脏纤维化程度较前改善,但治疗组较对照组改善明显,治疗12个月时两组比较差异有统计学意义(P<0.05)。治疗组PTA、Child-Pugh评分无恶化,而对照组部分病例出现恶化,两者比较差异均有统计学意义(P<0.05)。疗程结束时,治疗组患者未出现上消化道出血、肝性脑病、感染及肝肾综合征等严重并发症;而对照组发生率分别为5.56%、8.33%、2.78%、2.78%,两组间差异有统计学意义(P<0.05);对照组有1例患者死于上消化道大出血,1例患者死于肝肾综合征。结论恩替卡韦治疗血清HBV DNA阴性代偿期乙型肝炎肝硬化获得生化应答、组织学改善,减少相关并发症、失代偿期及死亡病例的发生。Objective To observe the prognosis of entecavir treatment for serum HBV DNA negative hepatitis B cirrhosis. Methods 76 patients with serum HBV DNA negative hepatitis B cirrhosis were randomly divided into two groups. The control group of 36 patients received the liver, hepatic fibrosis and symptomatic treatment. The treatment group of 40 patients were treated with entecavir 0.5 mg/d and symptomatic treatment; both courses of treatment were 12 months. Liver and kidney function, prothrombin time （PT）, liver fibrosis, Child-Pugh score and adverse drug reactions were observed and recorded. Results After 6 and 12 months treatment, the biochemical indexes of the treatment were significantly improved when compared with those of the control group（P〈0.05）. The degree of liver fibrosis was improve after treatment in both groups, but the improvement in the treatment group was significantly better than that of the control group after 12 months of treatment （P〈0.05）. The PTA and Child-Pugh scores of the treatment group were not deteriorated, while the scores of the control group were worsened in some patients. Both parallel differences were statistically significant （P〈0.05）. At the end of the treatment, there was not a case of upper gastrointestinal bleeding, hepatic encephalopathy, infection or liver and kidney syndrome and other serious complications in the treatment group, while the occurrence rates of these symptoms were 5.56%, 8.33%, 2.78%and 2.78%, respectively, in the control group. The difference between the two groups was statistically significant （P〈0.05）. In the control group, there was one patient died of upper digestive tract hemorrhage, and the other died of liver and kidney syndrome. Conclusion This research showed that the treatment of serum HBV DNA negative hepatitis B cirrhosis with entecavir could improve biochemical and histological indexes, and reduce postoperative complications, loss compensatory stage and deaths.

关 键 词：血清HBV DNA阴性 乙型肝炎肝硬化 恩替卡韦 

分 类 号：R512.62[医药卫生—内科学] R575.29[医药卫生—临床医学]