替诺福韦酯序贯治疗抗病毒失败的失代偿期CHB肝硬化对肝纤维化指标水平影响  

Effect of tenofovir dipivoxil sequential therapy on decompensated CHB cirrhosis patients with antiviral failure and its effect on hepatic fibrosis index levels

作　　者：陆蒂青[1] 闪海霞[1] 张怀宏[1] 吴玉卓[1] LU Di-qing;SHAN Hai-xia;ZHANG Huai-hong;WU Yu-zhuo(Department of Infectious Liver Diseases,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院感染肝病科,河南南阳473000

出　　处：《社区医学杂志》2021年第18期1111-1114,共4页Journal Of Community Medicine

摘　　要：目的研究抗病毒失败的失代偿期慢性乙型肝炎(CHB)肝硬化患者使用替诺福韦酯序贯治疗后对肝纤维化指标水平的影响。方法选取2018-06-15-2020-06-15南阳市中心医院感染肝病科收治的89例抗病毒治疗失败的失代偿期CHB肝硬化患者作为研究对象,采用组间匹配的方法分成2组。在护肝治疗基础上,对照组44例给予恩替卡韦序贯治疗,观察组45例给予替诺福韦酯序贯治疗,比较2组患者肝功能、血清病毒标志物及肝纤维化指标水平。结果观察组治疗后谷草转氨酶(AST)水平为(41.32±7.69)U/L,低于对照组的(55.12±8.23)U/L,t=8.176,P<0.001;总胆红素(TBIL)水平为(25.29±6.84)μmol/L,低于对照组的(29.79±7.12)μmol/L,t=3.041,P=0.003;谷丙转氨酶(ALT)水平为(33.70±5.89)U/L,低于对照组的(48.55±6.43)U/L,t=11.365,P<0.001。观察组治疗后乙型肝炎表面抗原(HBsAg)水平为(2.31±0.58)IU/mL,低于对照组的(2.89±0.62)IU/mL,t=4.559,P<0.001;乙肝病毒脱氧核糖核酸(HBV-DNA)水平为(3.25±0.72)IU/mL,低于对照组的(4.06±0.86)IU/mL,t=4.822,P<0.001;HBVDNA转阴率为93.33%,高于对照组的75.00%,χ^(2)=5.641,P=0.018。观察组治疗后层黏连蛋白(LN)水平为(84.26±8.44)ng/mL,低于对照组的(98.28±8.52)ng/mL,t=7.799,P<0.001;透明质酸(HA)水平为(91.45±9.22)ng/mL,低于对照组的(112.56±9.51)ng/mL,t=10.633,P<0.001;Ⅲ型前胶原肽(PⅢP)水平为(2.49±0.49)ng/mL,低于对照组的(3.92±0.53)ng/mL,t=13.221,P<0.001;Ⅳ型胶原(Ⅳ-C)水平为(75.23±7.36)ng/mL,低于对照组的(98.26±7.55)ng/mL,t=14.572,P<0.001。结论替诺福韦酯序贯治疗能够阻断HBV的复制,降低血清病毒标志物水平,有效改善肝功能,减轻肝纤维化程度。Objective To study the effect of tenofovir dipivoxil on hepatic fibrosis indexes after sequential treatment in patients with decompensated chronic hepatitis B(CHB)cirrhosis after antiviral failure.Methods Our hospital in June 2018 to June 2020,89 cases of antiviral treatment failure during the period of patients with decompensated CHB cirrhosis as the research target,using the random number table method to group,on the basis of protect liver treatment,44 cases were given entecavir sequential therapy,observation group 45 cases given tenofovir ester sequential treatment,compared two groups of patients with liver function,serum virus markers and liver fibrosis index level.Results After treatment,the aspartate aminotransferase(AST)level of the observation group was(41.32±7.69)U/L,lower than that of the control group(55.12±8.23)U/L,t=8.176,P<0.001.Total bilirubin(TBIL)level was(25.29±6.84)μmol/L,lower than that of control group(29.79±7.12)μmol/L,t=3.041,P=0.003.Alanine aminotransferase(ALT)level was(33.70±5.89)U/L,lower than that of control group(48.55±6.43)U/L,t=11.365,P<0.001.Hepatitis B surface antigen(HBsAg)level in the observation group after treatment was(2.31±0.58)IU/ml,lower than that in the control group(2.89±0.62)IU/ml,t=4.559,P<0.001.Hepatitis B virus deoxyribonucleic acid(HBV-DNA)level was(3.25±0.72)IU/ml,lower than that of the control group(4.06±0.86)IU/ml,t=4.822,P<0.001.The negative conversion rate of HBV-DNA was 93.33%,higher than that of the control group(75.00%),χ^(2)=5.641,P=0.018.The level of laminin(LN)was(84.26±8.44)ng/ml,lower than that of the control group(98.28±8.52)ng/ml,t=7.799,P<0.001.The level of hyaluronic acid(HA)was(91.45±9.22)ng/ml,lower than that of control group(112.56±9.51)ng/ml,t=10.633,P<0.001.The level ofⅢtype procollagen peptide(PⅢP)was(2.49±0.49)ng/ml,which was lower than that of the control group(3.92±0.53)ng/ml,t=13.221,P<0.001.The level ofⅣtype collagen(Ⅳ-C)was(75.23±7.36)ng/ml,lower than that of the control group(98.26±7.55)ng/ml,t=14.572,P<0.00

关 键 词：纤维化 乙型肝炎 替诺福韦酯 恩替卡韦 

分 类 号：R512.62[医药卫生—内科学]