恩替卡韦和阿德福韦酯治疗乙型病毒性肝炎肝硬化合并糖尿病临床效果对比分析  

Comparison of Clinical Efficacy between Entecavir and Adefovir Dipivoxil in Treatment of Viral Hepatitis Type B and Cirrhosis Combined with Diabetes Mellitus

作　　者：王永华[1] 陈雄兵[2] 张佳光[1] 黄利青[1] 石次国[1] 谭倩[1] 朱晓微[1] 

机构地区：[1]三峡大学第三临床医学院葛洲坝集团中心医院感染性疾病科,湖北宜昌443002 [2]三峡大学第三临床医学院葛洲坝集团中心医院内分泌科,湖北宜昌443002

出　　处：《解放军医药杂志》2017年第6期71-73,77,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：湖北省自然科学基金资助项目(2012FKB07501)

摘　　要：目的探讨恩替卡韦和阿德福韦酯治疗乙型病毒性肝炎肝硬化合并糖尿病的临床效果,并进行对比分析。方法选取2014年2月—2015年2月收治的84例乙型病毒性肝炎肝硬化合并糖尿病患者作为研究对象,按照治疗方法将患者分为观察组与对照组,每组42例。观察组给予口服恩替卡韦治疗,对照组给予口服阿德福韦酯治疗,两组均治疗48周。同时所有患者均给予糖尿病饮食、控制血糖及综合护肝、降酶等对症支持治疗。对比分析两组治疗前后肝功能、病毒学应答情况及血糖水平。结果两组治疗后总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)水平低于治疗前(P<0.05),白蛋白(Alb)水平高于治疗前(P<0.05)。治疗后,观察组TBil、DBil、ALT、AST水平低于对照组(P<0.05),Alb水平和病毒学应答率高于对照组(P<0.05)。治疗后,两组空腹血糖及糖化血红蛋白低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。结论相比阿德福韦酯,恩替卡韦治疗乙型病毒性肝炎肝硬化合并糖尿病,能明显改善肝功能,增强肝糖原代谢能力,更好的控制血糖,有利于提高患者预后生活质量。Objective To investigate clinical efficacy of Entecavir and Adefovir Dipivoxil in treatment of viral hepatitis type B and cirrhosis combined with diabetes mellitus, and to perform comparative analysis. Methods A total of 84 patients with viral hepatitis type B and cirrhosis combined with diabetes mellitus admitted during February 2014 and February 2015 were divided into observation group and control group according to treatment methods （n = 42 for each group）. Observation group was treated with Entecavir orally, while control group was treated with Adefovir Dipivoxil oral- ly. Both groups were treated for 48 weeks. All patients were given correspondingly supportive treatments such as diabetic diet, blood glucose control, comprehensive liver protection and decreasing enzyme. Liver function, virology response and blood glucose levels before and after treatment were analyzed in two groups. Results After treatment, total bilirubin （TBil）, direct bilirubin （DBil）, alanine transarninase （ALT） and aspartate aminotransferase （AST） levels were signifi- cantly lower （ P 〈 0.05 ）, while albumin （Alb） levels were significantly higher than those before treatment in two groups （P 〈 0.05）. In observation group, after treatment, TBil, DBil, ALT and AST levels were significantly lower than those in control group （ P 〈 0. 05 ）, while Alb level and virology response rate were significantly higher in observation group than those in control group （P 〈 0.05）. After treatment, levels of fasting blood glucose and glycosylated hemoglobin were significantly lower than those before treatment in two groups （ P 〈 0. 05 ） , and the levels in observation group was significantly lower than those in control group （P 〈 0.05）. Conclusion Compared with those by Adefovir Dipivoxil, Entecavir in treatment of patients with viral hepatitis type B and cirrhosis combined with diabetes mellitus can obviously improve liver function, enhance liver glycogen metabolism and well control blood glucose

关 键 词：恩替卡韦 阿德福韦酯 乙型肝炎 肝硬化 糖尿病 

分 类 号：R575.2[医药卫生—消化系统] R587.1[医药卫生—内科学]