拉米夫定和恩替卡韦治疗HBV相关慢加急性肝衰竭的效果及对IL-10、IFN-γ的影响  

Effects of Lamivudine and Entecavir on HBV Related Acute on Chronic Liver Failure and the Effects on IL-10 and IFN-γ

作　　者：刘贵章[1] 夏琴 冯霞[1] 李声方[1] 许静[1] 赵登蕴[1] 田庆杰[1] LIU Guizhang;XIA Qin;FENG Xia;LI Shengfang;XU Jing;ZHAO Dengyun;TIAN Qingjie(Dongguan Donghua Hospital,Dongguan 523110,China)

机构地区：[1]广东省东莞东华医院,广东东莞523110

出　　处：《中国医学创新》2020年第2期10-13,共4页Medical Innovation of China

基　　金：东莞市社会科技一般发展项目(201950715046916)。

摘　　要：目的:对比分析拉米夫定和恩替卡韦治疗乙型肝炎相关慢加急性肝衰竭(acute on chronic liver failure,ACLF)的效果及对白细胞介素-10(IL-10)、干扰素-γ(IFN-γ)的影响。方法:选取2015年2月-2018年6月来本院诊治的60例乙型肝炎相关ACLF患者。根据用药不同将患者分为拉米夫定组和恩替卡韦组,各30例。拉夫米定组给予拉米夫定治疗,恩替卡韦组给予恩替卡韦治疗。比较两组的总胆红素(TBIL)、谷丙转氨酶(ALT)、白蛋白(ALB)、凝血酶原活动度(PTA)、IL-10、IFN-γ、HBV DNA转阴率,并比较预后终末期肝病模型(MELD)评分。结果:与治疗前比较,两组治疗后的TBIL、ALT、IL-10、IFN-γ和MELD评分均降低,差异均有统计学意义(P<0.05);与治疗前比较,两组治疗后的ALB、PTA均升高,差异均有统计学意义(P<0.05)。治疗后,恩替卡韦组的IL-10、IFN-γ及MELD评分均低于拉米夫定组,PTA、HBV DNA转阴率均高于拉米夫定组,差异均有统计学意义(P<0.05)。治疗后,恩替卡韦组的TBIL、ALT均低于拉米夫定组,ALB高于拉米夫定组,差异均有统计学意义(P<0.05)。结论:恩替卡韦相对于拉米夫定在乙型肝炎相关ACLF的治疗中具有更好的效果。Objective: To compare and analyze the effect of Lamivudine and Entecavir in the treatment of HBV related acute on chronic liver failure(ACLF) and the effect on interleukin-10(IL-10) and IFN-γ. Method: From February 2015 to June 2018, 60 patients with chronic HBV related ACLF were diagnosed and treated in our hospital. The patients were divided into the Lamivudine group and the Entecavir group, 30 cases in each group, depending on the medication. Lamivudine was given in the Lavmidine group and Entecavir was given in the Entecavir group. Total bilirubin(TBIL), alanine aminotransferase(ALT), albumin(ALB), prothrombin activity(PTA), IL-10, IFN-γ, HBV DNA negative rate, and the prognostic end-stage liver disease model(MELD) score were compared between the two groups. Result: Compared to before treatment, the TBIL, ALT, IL-10, IFN-γ and MELD scores of the two groups after treatment were all decreased, with statistically significant differences(P<0.05). Compared to before treatment, ALB and PTA increased after treatment in both groups, with statistically significant differences(P<0.05). After treatment, the IL-10, IFN-γ and MELD score in the Entecavir group were lower than those in the Lamivudine group, while the PTA and HBV DNA negative conversion rate were higher than those in the Lamivudine group, with statistically significant differences(P<0.05). After treatment, the TBIL and ALT of Entecavir group were lower than those of Lamivudine group, and the ALB was higher than that of Lamivudine group, with statistically significant differences(P<0.05). Conclusion: Entecavir is more effective in the treatment of chronic and acute HBV related ACLF than Lavmidine.

关 键 词：拉米夫定 恩替卡韦 HBV 慢加急性肝衰竭 IL-10 IFN-Γ 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]