恩替卡韦联合苦参素治疗HBeAg阳性慢性乙型肝炎  

Entecavir combined with kushenin in the treatment of patients with HBe Ag-positive chronic hepatitis B

作　　者：张毅[1] 余永胜[1] 汤正好[1] 陈小华[1] 王鹏[1] 江红[1] 奚敏[1] 臧国庆[1] ZHANG ~i YU ~ongsheng TANG Zhenghao CHEN Xiaohua WANG Peng JIANG Hong XI Min ZANG Guoqing(Department of lnfectious Diseases, Shanghai Jiao Tong University Affiliated Sixth People＇s Hospital, Shanghai 200233, Chin)

机构地区：[1]上海交通大学附属第六人民医院感染病科,上海200233

出　　处：《中国热带医学》2016年第12期1208-1211,共4页China Tropical Medicine

基　　金：上海市卫生和计划生育委员会中医药科研基金(No.2014JQ019A)

摘　　要：目的探讨恩替卡韦联合苦参素治疗HBeAg阳性慢性乙型肝炎(chronic hepatitis B,CHB)的临床疗效。方法将216例HBeAg阳性CHB患者随机分为治疗组和对照组。治疗组112例给予恩替卡韦联合苦参素治疗,对照组104例给予恩替卡韦治疗,疗程48周。治疗48周后,观察两组患者ALT水平、ALT复常率、HBV-DNA水平、HBV-DNA阴转率、HBeAg阴转率、HBeAg/HBeAb血清转换率及外周血T细胞亚群变化。结果治疗48周后,两组患者血清ALT水平均下降,ALT复常率分别为93.75%、87.50%,但两组间差异无统计学意义(P>0.05);两组患者血清HBV-DNA水平均下降,且治疗组血清HBV-DNA水平较对照组下降[(2.13±0.74)lg IU/mL vs.(3.98±1.61)lg IU/mL,P<0.01];治疗组HBV-DNA、HBeAg阴转率及HBeAg/HBe Ab血清转换率高于对照组(92.86%vs.83.65%,32.14%vs.19.23%,30.36%vs.18.27%,P均<0.05);治疗组CD4^+T细胞百分率及CD4^+T/CD8^+T比值上升,CD8^+T细胞百分率下降,与治疗前比较,差异有统计学意义[(26.76±6.32)%vs.(38.59±7.13)%,(0.93±0.32)vs.(1.70±0.36),(28.25±7.48)%vs.(22.47±5.91)%,P均<0.01];而对照组上述3项指标同治疗前比较,差异无统计学意义(P>0.05);治疗组CD4^+T细胞百分率及CD4^+T/CD8+T比例较对照组升高[(38.59±7.13)%vs.(27.41±6.57)%,(1.70±0.36)vs.(1.02±0.28),P均<0.01],而治疗组CD8^+T细胞百分率较对照组下降[(22.47±5.91)%vs.(26.33±5.76)%,P<0.01]。结论恩替卡韦与苦参素联合使用能有效增强抗HBV作用,同时能显著改善HBeAg阳性CHB患者外周血T淋巴细胞亚群状态。Objective We evaluated the clinical efficacy of entecavir（ETV） combined with kushenin in the treatment of patients with HBe Ag-positive chronic hepatitis B（CHB）. Methods A total of 216 patients with HBe Ag-positive CHB were randomly divided into treatment group（n=112） and control group（n=104）. Patients in the control group were treated with ETV,while patients in the treatment group were treated with ETV combined with kushenin. All patients were treated for 48 weeks.Serum alanine aminotransferase（ALT）, ALT normalization rates, serum HBV- DNA loads, the negative conversion rates of HBV-DNA and HBe Ag, and the seroconversion rates of HBe Ag/HBe Ab and changes in peripheral T lymphocyte subsets were observed at 48 weeks of treatment. Results At 48 weeks of treatment, the levels of serum ALT decreased and the ALT normalization rates were 93.75% and 87.50% in the treatment group and the control group, respectively. Nevertheless, there was no significant difference between these two groups（P〉0.05）. At 48 weeks of treatment, the HBV-DNA loads significantly decreased in both groups. Furthermore, compared with the control group, the HBV- DNA loads in the treatment group significantly decreased[（2.13±0.74） lg IU/mL vs.（3.98±1.61） lg IU/m L, P〈0.01]. The negative conversion rates of HBV-DNA and HBe Ag and the seroconversion rates of HBe Ag/HBe Ab in the treatment group were significantly higher than those in the control group（92.86% vs. 83.65%, 32.14% vs. 19.23%, 30.36% vs. 18.27%, respectively, all P〈0.05）. In the treatment group,the percentage of CD4^＋T lymphocytes and the ratio of CD4^＋T/CD8^＋T significantly increased, while the percentage of CD8^＋T lymphocytes significantly decreased after the combined treatment with ETV and kushenin[（26.76±6.32）% vs.（38.59±7.13）%,（0.93±0.32） vs.（1.70±0.36）,（28.25±7.48）% vs.（22.47±5.91）%, respectively, all P〈0.01]. However, in the control group, there was no significant difference in the above three indic

关 键 词：慢性乙型肝炎 恩替卡韦 苦参素 临床疗效 T淋巴细胞亚群 

分 类 号：R512.62[医药卫生—内科学]