恩替卡韦联合胸腺肽治疗HBeAg阳性慢性乙型肝炎患者的临床效果  

Clinical effect of entecavir combined with thymosin in treatment of HBe Ag-positive hepatitis B patients

作　　者：黄玲[1] 宁惠明 徐燕华[1] 汤群[1] 欧强[1] 

机构地区：[1]上海市第八人民医院,上海200235

出　　处：《临床肝胆病杂志》2016年第11期2070-2074,共5页Journal of Clinical Hepatology

摘　　要：目的研究HBe Ag阳性慢性乙型肝炎(CHB)患者应用恩替卡韦(ETV)联合胸腺肽治疗的临床疗效。方法纳入2012年3月-2015年3月于上海市第八人民医院传染病科就诊的HBe Ag阳性CHB患者108例,根据平行、单盲、随机对照原则分为对照组(54例)和观察组(54例)。两组均接受内科综合治疗,对照组单用ETV治疗,观察组应用ETV联合胸腺肽治疗。对比两组肝功能指标、病毒学指标、免疫指标及肝纤维化指标变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗48周后,观察组的肝功能指标(Alb/Glo、ALT、AST、TBil)与对照组比较差异均有统计学意义[(1.73±0.57)vs(1.50±0.51)、(42.58±14.32)U/L vs(54.26±18.78)U/L、(35.79±10.33)U/L vs(49.97±17.84)U/L、(18.89±6.02)μmol/L vs(25.24±9.06)μmol/L,t值分别为2.210、3.634、5.055、4.290,P值均<0.05];治疗48周后,观察组的肝纤维化指标(层黏连蛋白、透明质酸、Ⅳ型胶原片段、Ⅲ型前胶原)与对照组比较差异均有统计学意义[(65.34±11.02)ng/ml vs(102.57±16.41)ng/ml、(91.68±11.53)ng/ml vs(151.23±16.71)ng/ml、(81.02±12.64)μg/ml vs(118.47±18.01)μg/ml、(70.44±13.06)μg/ml vs(91.57±17.16)μg/ml,t值分别为13.840、21.555、12.507、7.200,P值均<0.001];治疗12、24及48周时,观察组HBe Ag阴转率分别为29.63%、46.30%、57.41%,显著高于对照组的12.96%、22.22%、25.93%(χ2值分别为4.475、6.948、11.009,P值均<0.05);治疗48周后观察组的血清IL-4为(2.69±1.23)pg/ml,显著低于对照组的(4.38±1.44)pg/ml(t=6.558,P<0.001),IFNγ水平为(1.82±0.89)pg/ml,显著高于对照组的(1.12±0.56)pg/ml(t=4.812,P<0.001);观察组的不良反应率为3.70%,与对照组的1.85%比较,差异无统计学意义(χ2=0.343,P=0.558)。结论 HBe Ag阳性CHB患者应用恩替卡韦联合胸腺肽治疗能够促进肝功能康复,调节免疫功能,提高HBe Ag阴转率并抑制肝纤维化进程。Objective To investigate the clinical effect of entecavir（ ETV） combined with thymosin in the treatment of HBe Ag- positive chronic hepatitis B（ CHB） patients. Methods A total of 108 HBe Ag- positive CHB patients who were treated in Department of Infectious Diseases in our hospital from March 2012 to March 2015 were enrolled,and according to the parallel,single- blind,randomized controlled principles,the patients were divided into control group（ 54 patients） and observation group（ 54 patients）. The patients in both groups were given comprehensive medical treatment; the patients in the control group were treated with ETV alone,and those in the observation group were treated with ETV combined with thymosin. The changes in liver function parameters,virological parameters,immune indices,and liver fibrosis indicators were compared between the two group. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver function parameters albumin / globulin ratio（ 1. 73 ± 0. 57 vs 1. 50 ± 0. 51,t =2. 210,P〈0. 05）,alanine aminotransferase（ 42. 58 ± 14. 32 U / L vs 54. 26 ± 18. 78 U / L,t = 3. 634,P〈0. 05）,aspartate aminotransferase（ 35. 79 ± 10. 33 U / L vs 49. 97 ± 17. 84 U / L,t = 5. 055,P〈0. 05）,and total bilirubin（ 18. 89 ± 6. 02 μmol / L vs 25. 24 ± 9. 06μmol /L,t = 4. 290,P〈0. 05）. After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver fibrosis indicators laminin（ 65. 34 ± 11. 02 ng / ml vs 102. 57 ± 16. 41 ng / ml,t = 13. 840,P〈0. 001）,hyaluronic acid（ 91. 68 ± 11. 53 ng / ml vs 151. 23 ± 16. 71 ng / ml,t = 21. 555,P〈0. 001）,type IV collagen（ 81. 02 ± 12. 64 μg / ml vs 118. 47 ±18. 01 μg / ml,t = 12. 507,P〈0. 001）,and procollagen III（ 70. 44 ±

关 键 词：肝炎 乙型 慢性 肝炎e抗原 乙型 恩替卡韦 胸腺肽 对比研究 

分 类 号：R512.62[医药卫生—内科学]