恩替卡韦联合替诺福韦治疗病毒性乙型肝炎肝衰竭的效果观察  

Short-term efficacy and safety of dual antiviral entecavir combined with tenofovir in the treatment of liver failure in viral hepatitis B

作　　者：戴小灵 古宝欢 杨振辉 曾剑清 何佳良 DAI Xiaoling;GU Baohuan;YANG Zhenhui;ZENG Jianqing;HE Jialiang(Department of Hepatology,East Guangdong Hospital,the Third Affiliated Hospital of Sun Yat-Sen University,Meizhou,Guangdong 514021,China)

机构地区：[1]中山大学附属第三医院粤东医院肝脏内科,广东梅州514021

出　　处：《医药前沿》2022年第34期1-3,共3页Journal of Frontiers of Medicine

摘　　要：目的:观察恩替卡韦(ETV)联合替诺福韦(TDF)治疗病毒性乙型肝炎(HBV)肝衰竭的临床疗效与安全性。方法:选取中山大学附属第三医院粤东医院2018年6月—2021年6月收治的126例病毒性乙型肝炎肝衰竭患者,采用简单随机分组法将患者分为观察组与对照组各63例。对照组在常规护肝治疗基础上联合恩替卡韦治疗,观察组在对照组基础上联合替诺福韦治疗。对比两组患者治疗前后的总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、肌酐(CR)、凝血酶原时间(PT)、HBV-DNA病毒载量水平及转阴率。结果:治疗后,两组患者TBIL、ALT、AST、PT、HBV-DNA水平均较本组治疗前降低,且观察组患者上述生化指标低于对照组,差异有统计学意义(P<0.05)。第8周观察组HBV-DNA的转阴率(95.2%)高于对照组(73.0%),差异有统计学意义(P<0.05)。两组肾功能BUN、CR无显著差异(P>0.05)。结论:ETV与TDF双联抗病毒可加速改善乙型肝炎肝衰竭患者肝功能,更快速抑制肝炎病毒复制,加快预后恢复,安全性较好,值得临床应用。Objective To investigate the clinical efficacy and safety of entecavir(ETV)combined with tenofovir(TDF)in the treatment of viral hepatitis B(HBV)liver failure.Methods 126 patients with hepatitis B liver failure admitted in East Guangdong Hospital,the Third Affiliated Hospital of Sun Yat-Sen University,from June 2018 to June 2021 were randomly divided into the observation group(63 cases)and the control group(63 cases).The control group was treated with entecavir on the basis of routine liver protection treatment,and the observation group was treated with tenofovir on the basis of the control group.Total bilirubin(TBIL),alanine transaminase(ALT),glutamate transaminotransferase(AST),urea nitrogen(BUN),creatinine(CR),prothrombin time(PT),HBV-DNA viral load levels and negative rate.Results After treatment,the levels of TBIL,ALT,AST,PT and HBV DNA in the two groups were lower than those before treatment,and the levels of the above biochemical indexes and PT in the observation group were significantly lower than those in the control group(P<0.05).At the first,second,third,fourth,fifth,sixth and eighth week of treatment,the precipitation of HBV DNA in the patients was higher than that in the control group on average(P<0.05).At the eighth week,the negative rate of HBV DNA was analyzed.The observation group(60/63=95.2%)were better than the control group(46/63=73.0%,P<0.01).There was no significant change in BUN and CR of renal function.Conclusion The combination of entecavir and tenofovir can accelerate the improvement of liver function in patients with hepatitis B liver failure,inhibit the replication of hepatitis virus more rapidly,and accelerate the recovery of prognosis without obvious side effects.

关 键 词：恩替卡韦 替诺福韦 乙型肝炎 肝衰竭 

分 类 号：R512.6[医药卫生—内科学]