恩替卡韦治疗失代偿期乙型肝炎肝硬化  

Efficacy of entecavir in the treatment of decompensated hepatitis B cirrhosis

作　　者：张丽丽[1] 刘涛[1] 马欢[1] 杨建波[1] 罗玉君[1] ZHANG Lili;LIU Tao;MA Huan;YANG Jianbo;LUO Yujun((Department of Gastroenterology, Mianyang Central Hospital, Mianyang 621000, Sichuan, China)

机构地区：[1]绵阳市中心医院消化内科,四川绵阳621000

出　　处：《西部医学》2020年第7期999-1002,1006,共5页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(18PJ395)。

摘　　要：目的探究恩替卡韦治疗失代偿期乙型肝炎肝硬化的疗效及对患者血浆结缔组织生长因子(CTGF)、血小板衍生生长因子(PDGF)水平的影响。方法回顾性分析2017年1月~2018年1月我院238例失代偿期乙型肝炎肝硬化患者临床资料,根据其治疗方法分为拉米夫定联合阿德福韦酯治疗组(对照组,109例)及恩替卡韦治疗组(观察组,129例)。记录两组治疗24、48周乙型肝炎病毒脱氧核糖核酸(HBV DNA)阴转率、谷丙转氨酶(ALT)复常率、耐药率及治疗期间不良反应发生情况,并比较两组治疗前及治疗48周后肝功能(Child Pugh评分)、肝纤维程度[瞬时弹性测定检测肝脏硬度值(LSM)、超声量化评分]及血清学指标(CTGF、PDGF)。结果治疗24、48周时,观察组HBV DNA阴转率、ALT复常率均高于对照组(P<0.05)。两组耐药率及治疗期间不良反应发生情况比较差异无统计学意义(P>0.05)。治疗48周后,两组Child Pugh评分,肝纤维程度(LSM、超声量化评分),血清学指标(CTGF、PDGF)均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。结论恩替卡韦治疗失代偿期乙型肝炎肝硬化效果优于拉米夫定联合阿德福韦酯,抗病毒作用更佳,能使患者肝功能及肝纤维化程度改善,安全性也较高,临床应用价值高。Objective To explore the efficacy of entecavir in the treatment of decompensated hepatitis B cirrhosis and its effects on levels of plasma connective tissue growth factor(CTGF)and platelet-derived growth factor(PDGF).Methods The clinical data of 238 patients with decompensated hepatitis B cirrhosis in our hospital were retrospectively analyzed.According to the treatment methods,they were divided into lamivudine+adefovir dipivoxil treatment group(control group,109 cases)and entecavir treatment group(observation group,129 cases).The negative conversion rate of hepatitis B virus desoxyribonucleic acid(HBV DNA),reversion rate of alanine aminotransferase(ALT),drug resistance rate and occurrence of adverse reactions during treatment were recorded in the two groups at 24 weeks and 48 weeks of treatment,and the liver function(Child Pugh score),liver fibrosis degree[transient elasticity test for liver stiffness measure(LSM),ultrasound quantitative score]and serological indicators(CTGF,PDGF)were compared between the two groups before treatment and after 48 weeks of treatment.Results At 24 weeks and 48 weeks of treatment,the HBV DNA negative conversion rate and ALT reversion rate in observation group were higher than those in control group(P<0.05).There were no significant differences in the drug resistance rate and occurrence of adverse reactions between the two groups during treatment(P>0.05).After 48 weeks of treatment,the Child Pugh score,liver fibrosis degree(LSM,ultrasound quantitative score)and serological indicators(CTGF,PDGF)in the two groups were lower than those before treatment(P<0.05),and the indexes in observation group were lower than those in control group(P<0.05).Conclusion Entecavir has better effects and better antiviral effect than lamivudine+adefovir dipivoxil in the treatment of decompensated hepatitis B cirrhosis,and it can improve the liver function and liver fibrosis of patients,and it has high safety and high clinical application value.

关 键 词：恩替卡韦 乙型肝炎肝硬化 失代偿期 CTGF PDGF 

分 类 号：R575.2[医药卫生—消化系统]