水飞蓟素胶囊联合替诺福韦对失代偿期乙肝肝硬化患者肝肾功能、肝纤维化及氧化应激水平的影响  

The effect of silymarin capsule combined with tenofovir on liver and kidney function,liver fibrosis and oxidative stress level in patients with decompensated hepatitis B cirrhosis

作　　者：郭香娟[1] 王敏[1] 张洪涛[1] 卢力飞 宋欢欢[1] 范晓英[1] 聂尚燕[1] 郭红[1] 张肖[1] Guo Xiangjuan;Wang Min;Zhang Hongtao;Lu Lifei;Song Huanhuan;Fan Xiaoying;Nie Shangyan;Guo Hong;Zhang Xiao(Department of Infectious Diseases,Handan Central Hospital of Hebei Province,Hebei Province,Handan 056000,China)

机构地区：[1]河北省邯郸市中心医院感染性疾病科,056000

出　　处：《疑难病杂志》2020年第10期980-984,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省邯郸市科学技术研究与发展计划项目(1823208062ZC)。

摘　　要：目的观察水飞蓟素胶囊联合替诺福韦对失代偿期乙肝肝硬化患者肝肾功能、肝纤维化指标及氧化应激水平的影响。方法选择2017年2月—2018年12月河北省邯郸市中心医院感染性疾病科诊治的失代偿期乙肝肝硬化患者98例,按随机数字表法分为2组,各49例,对照组应用替诺福韦治疗,观察组应用水飞蓟素胶囊联合替诺福韦治疗,比较2组肝肾功能、肝纤维化指标、氧化应激水平及血清病毒学指标转归、不良反应发生情况。结果治疗48周后,观察组患者血清总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平低于对照组,白蛋白(ALB)水平高于对照组(t/P=5.382/0.000、14.767/0.000、7.642/0.000、4.555/0.000);血肌酐(SCr)、尿素氮(BUN)水平与对照组比较差异无统计学意义(P>0.05);观察组层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PC-Ⅲ)、透明质酸(HA)水平低于对照组(t/P=4.392/0.000、3.653/0.000、6.392/0.000、5.597/0.000);观察组一氧化氮(NO)、丙二醛(MDA)水平低于对照组,超氧化物歧化酶(SOD)水平高于对照组(t/P=3.601/0.001、5.540/0.000、3.487/0.001);观察组HBV-DNA转阴率为95.92%,HBeAg转阴率为46.94%,均高于对照组的83.67%、26.53%(χ^2/P=4.009/0.045、4.391/0.036);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论水飞蓟素胶囊联合替诺福韦治疗失代偿期乙肝肝硬化患者能够发挥良好抗病毒效果,且可以明显改善肝功能,减轻氧化应激,改善肝纤维化状况,同时对肾功能无明显损害。Objective To observe the effect of silymarin capsule combined with tenofovir on liver and kidney function,liver fibrosis index and oxidative stress level in patients with decompensated hepatitis B cirrhosis.Methods From February 2017 to December 2018,98 patients with decompensated hepatitis B liver cirrhosis who were diagnosed and treated in the Department of Infectious Diseases,Handan Central Hospital,Hebei Province,were divided into 2 groups according to the random number table method,each with 49 cases,and the control group In the treatment of tenofovir,the observation group was treated with silymarin capsules combined with tenofovir,and the liver and kidney function,liver fibrosis indexes,oxidative stress level,serum virological index outcome,and adverse reactions were compared between the two groups.Results After 48 weeks of treatment,serum total bilirubin(TBil),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels in the observation group were lower than those in the control group,and albumin(ALB)levels were higher Compared with the control group(t/P=5.382/0.000,14.767/0.000,7.642/0.000,4.555/0.000);serum creatinine(SCr)and urea nitrogen(BUN)levels were not significantly different from the control group(P>0.05);The levels of laminin(LN),typeⅣcollagen(Ⅳ-C),type III procollagen(PC-Ⅲ)and hyaluronic acid(HA)in the observation group were lower than those in the control group(t/P=4.392/0.000,3.653/0.000,6.392/0.000,5.597/0.000);the observation group has lower levels of nitric oxide(NO)and malondialdehyde(MDA)than the control group,and the level of superoxide dismutase(SOD)is higher than that of the control group(t/P=3.601/0.001,5.540/0.000,3.487/0.001);the negative rate of HBV-DNA in the observation group was 95.92%,and the negative rate of HBeAg was 46.94%,both higher than those in the control group of 83.67%and 26.53%(χ^2/P=4.009/0.045,4.391/0.036);there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Silymarin capsules combin

关 键 词：水飞蓟素胶囊 替诺福韦 乙肝肝硬化 失代偿期 肝功能 肾功能 肝纤维化 氧化应激 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]