国产恩替卡韦对HBeAg阳性代偿期乙肝肝硬化患者HBV复制的抑制效果、血清球蛋白及补体C3、C4的影响研究  

Effects of domestic entecavir on HBV replication,serum globulin,C3 and C4 in patients with HBeAg positive compensatory hepatitis B cirrhosis

作　　者：袁媛[1] 陈洁[1] 杨雪梅[1] 邓兰[1] YUAN Yuan;CHEN Jie;YANG Xue-mei;DENG Lan(Department of Infection,First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan,China)

机构地区：[1]成都医学院第一附属医院感染科,四川成都610500

出　　处：《川北医学院学报》2020年第3期432-435,449,共5页Journal of North Sichuan Medical College

基　　金：四川省医学会感染性肝病(深圳健安)专项科研课题(2017SZJA09)。

摘　　要：目的:探讨国产恩替卡韦(ETV)对乙型肝炎E抗原(HBeAg)阳性代偿期乙肝肝硬化患者乙型肝炎病毒(HBV)复制的抑制效果、血清球蛋白和补体C3、C4的影响。方法:按数表法将80例血清HBeAg阳性代偿期乙肝肝硬化患者随机分为EVT组和阿德福韦酯(ADV)组,每组各40例。常规对症治疗基础上,EVT组给予恩替卡韦治疗,ADV组给予阿德福韦酯治疗,两组均持续治疗48周。观察两组患者治疗后外周血中乙肝病毒脱氧核糖核酸(HBV-DNA)载量、HBV-DNA转阴率、HBeAg转阴率情况,并检测血清免疫球蛋白IgG、IgA、IgM和补体C3、C4水平,记录两组药物副反应发生率。结果:治疗48周后,两组患者HBV-DNA载量均较治疗前显著下降(P<0.05),EVT组HBV-DNA载量(2.20±0.64)LgIU/mL低于ADV组的(2.92±0.86)LgIU/mL,EVT组HBV-DNA载量降低值(3.46±0.98)LgIU/mL高于ADV组的(2.95±1.01)LgIU/mL,差异有统计学意义(P<0.05),EVT组HBV-DNA转阴率95%、HBeAg转阴率67.5%均高于ADV组的77.5%、40%,差异有统计学意义(P<0.05)。治疗48周后,两组血清IgG、IgA、IgM水平均明显下降,补体C3、C4水平均明显升高,差异有统计学意义(P<0.05),EVT组血清IgG(13.22±2.91)g/L、IgA(3.39±1.01)g/L、IgM(1.56±0.28)g/L低于ADV组的(15.34±2.95)g/L、(4.00±1.07)g/L、(1.75±0.31)g/L,EVT组补体C3(1.19±0.33)mg/L、C4(0.28±0.08)mg/L高于ADV组的(0.95±0.18)mg/L、(0.24±0.07)mg/L,差异有统计学意义(均P<0.05)。两组药副反应主要包括胃肠道反应、疲乏、肝区不适、失眠和谷丙转氨酶(ALT)异常升高,组间比较差异无统计学意义(P>0.05)。结论:HBeAg阳性代偿期乙肝肝硬化患者给予EVT抗病毒治疗能显著抑制HBV复制,降低血清IgG、IgA、IgM和提高补体C3、C4水平,对促进体液免疫功能恢复和改善预后具有重要作用。Objective:To investigate the inhibitory effect of domestic entecavir(ETV)on hepatitis B virus(HBV)replication and the effect of serum globulin and complement C3 and C4 in patients with compensatory hepatitis B cirrhosis with positive HBeAg.Methods:A total of 80 patients with HBeAg positive compensatory hepatitis B cirrhosis were selected as the study objects.They were divided into EVT group(n=40)and ADV group(n=40).On the basis of routine symptomatic treatment,EVT group was treated with entecavir dispersible tablets orally,ADV group was treated with adefovir dipivoxil dispersible tablets orally,both groups were treated continuously for 48 weeks.The HBV-DNA load,HBV-DNA negative rate and HBeAg negative rate in the peripheral blood of the two groups were observed after treatment,and the serum immunoglobulin IgG,IgA,IgM and complement C3,C4 levels were detected,and the incidence of side effects of the two groups were recorded.Results:After 48 weeks of treatment,HBV-DNA load decreased significantly(P<0.05).After 48 weeks of treatment,HBV-DNA load(2.20±0.64)lgIU/mL in EVT group was lower than those in ADV group(2.92±0.86)lgIU/mL and HBV-DNA load decreased(3.46±0.98)lgIU/mL in EVT group was higher than those in ADV group(2.95±1.01)lgIU/mL,with statistically significant difference(P<0.05).The negative rates of HBV-DNA and HBeAg in EVT group were 95.00%and 67.50%respectively,which were higher than those in ADV group(77.5%,40%),the difference was statistically significant(P<0.05).After 48 weeks of treatment,the levels of serum IgG,IgA,IgM were significantly lower,the levels of complement C3 and C4 were significantly higher in two groups,the difference was statistically significant(P<0.05).After 48 weeks of treatment in EVT group,the levels of IgG(13.22±2.91)g/L,IgA(3.39±1.01)g/L and IgM(1.56±0.28)g/L were significantly lower than that of ADV group(15.34±2.95)g/L,(4.00±1.07)g/L,(1.75±0.31)g/L.Complement C3(1.19±0.33)mg/L,C4(0.28±0.08)mg/L in EVT group were higher than ADV group(0.95±0.18)mg/L,(0.24±0.07)mg/L,

关 键 词：恩替卡韦 乙肝肝硬化 代偿期 HBEAG阳性 复制 血清球蛋白 补体 

分 类 号：R512.62[医药卫生—内科学]