恩替卡韦联合乳果糖治疗乙型肝炎后肝硬化的临床效果及对血清HBV-DNA、KLF2和TNFSF15的影响  

Clinical Efficacy of Entecavir Combined with Lactulose in the Treatment of Post-hepatitis B Cirrhosis and Its Effects on Serum HBV-DNA,KLF2 and TNFSF15

作　　者：王洪贵[1] 唐仕炜[1] 郑咏池[1] WANG Hong-gui;TANG Shi-wei;ZHENG Yong-chi(Department of Pharmacy,Dujiangyan People's Hospital,Dujiangyan,Sichuan 611830,China)

机构地区：[1]都江堰市人民医院药剂科,四川都江堰611830

出　　处：《临床误诊误治》2020年第6期33-37,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生和计划生育委员会科研课题(17PJ571)。

摘　　要：目的探讨恩替卡韦联合乳果糖治疗乙型肝炎后肝硬化的临床效果及对血清乙型肝炎病毒(HBV)-DNA、锌指样转录因子2(krüppel-like factor 2,KLF2)和肿瘤坏死因子超家族成员15(tumor necrosis factor superfamily member 15,TNFSF15)的影响。方法选取2017年1月—2019年1月收治的190例乙型肝炎后肝硬化,按照治疗方法的不同,分为观察组与对照组,每组各95例。观察组予恩替卡韦+乳果糖+常规治疗,对照组予恩替卡韦+常规治疗。两组均治疗6个月。记录治疗后6个月的临床疗效,检测治疗前、治疗后6个月的肝功能相关指标[丙氨酸转氨酶(ALT)、总胆红素(TB)]、肝纤维化相关指标[透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)]及细胞因子相关指标(KLF2、TNFSF15)的水平变化,比较治疗前及治疗后3、6个月血清HBV-DNA水平,观察不良反应发生情况。结果与对照组比较,观察组治疗总有效率升高,差异有统计学意义(P<0.05)。与对照组比较,观察组治疗后6个月ALT、TB、HA、LN、PC-Ⅲ、KLF2水平下降,TNFSF15水平升高,差异有统计学意义(P<0.01);与本组治疗前比较,两组治疗后6个月ALT、TB、HA、LN、PC-Ⅲ、KLF2水平下降,TNFSF15水平升高,差异有统计学意义(P<0.01)。与对照组比较,观察组治疗后3、6个月血清HBV-DNA水平下降,差异有统计学意义(P<0.01);与本组治疗前比较,两组治疗后3、6个月血清HBV-DNA水平下降,差异有统计学意义(P<0.01);与本组治疗后3个月比较,两组治疗后6个月血清HBV-DNA水平下降,差异有统计学意义(P<0.01)。两组不良反应总发生率比较差异无统计学意义(P>0.05),均予对症处理后症状消失。结论恩替卡韦联合乳果糖治疗乙型肝炎后肝硬化的临床效果较好,可改善肝功能,抑制肝纤维化,降低血清HBV-DNA水平,调控细胞因子的表达,且不良反应未明显增加。Objective To explore the clinical efficacy of Entecavir combined with Lactulose in the treatment of post-hepatitis B cirrhosis(PHBC)and its effects on serum hepatitis B virus deoxyribonucleic acid(HBV-DNA),krüppel-like factor 2(KLF2)and tumor necrosis factor superfamily member 15(TNFSF15).Methods A total of 190 patients with PHBC who were treated between January 2017 and January 2019 in our hospital were selected and randomly divided into observation group(n=95)and control group(n=95).Control group was treated with Entecavir and conventional treatment,while observation group was supplemented with Lactulose on the basis of control group,and they were treated for 6 months.Clinical efficacy at 6 months after treatment was recorded,and changes in liver function-related indicators[alanine aminotransferase(ALT),total bilirubin(TB)]and liver fibrosis-related indexes[hyaluronic acid(HA),laminin(LN),typeⅢprocollagen(PC-Ⅲ)],and cytokine-related indexes(KLF2,TNFSF15)before treatment and at 6 months after treatment were compared.Serum HBV-DNA levels before treatment and at 3 and 6 months after treatment were compared.The occurrence of adverse reactions was observed.Results After treatment,the total effective rate in observation group was significantly higher than that in control group(P<0.05).Compared with the control group,the levels of ALT,TB,HA,LN,PC-Ⅲ,and KLF2 were decreased and the level of TNFSF15 was increased in the observation group at 6 months after treatment(P<0.01).Compared with those in the same group before treatment,the levels of ALT,TB,HA,LN,PC-Ⅲand KLF2 were significantly decreased,while the level of TNFSF15 was increased at 6 months after treatment in the two groups(P<0.01).Compared with the control group,the serum HBV-DNA level in the observation group was significantly decreased at 3 and 6 months after treatment(P<0.01).Compared with those in the same group before treatment,the level of serum HBV-DNA was decreased in both groups at 3 and 6 months after treatment(P<0.01).Compared with those at 3 m

关 键 词：肝硬化 乙型肝炎 恩替卡韦 乳果糖 透明质酸 层黏连蛋白 乙型肝炎病毒 锌指样转录因子2 肿瘤坏死因子超家族成员15 

分 类 号：R575.29[医药卫生—消化系统]