恩替卡韦联合替诺福韦对乙型肝炎肝衰竭抗病毒疗效及MELD评分的影响  

Effect of Entecavir combined with Tenofovir on antiviral efficacy and MELD score in hepatitis B liver failure

作　　者：任娟[1] 伍孝贤[1] 苏晔 刘莉莉 REN Juan;WU Xiao-Xian;SU Ye;LIU Li-li(Department of Infectious Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院感染性疾病科,郑州450052

出　　处：《医药论坛杂志》2023年第19期94-97,共4页Journal of Medical Forum

摘　　要：目的分析乙型肝炎肝衰竭患者联合使用恩替卡韦与替诺福韦对患者终末期肝病的严重程度评分(Model for end-stage liver disease,MELD)、肝功能变化的影响。方法选取2020年12月—2021年12月郑州大学第一附属医院收治的乙型肝炎肝衰竭患者92例,按治疗药物的不同分为常规组(接受恩替卡韦胶囊治疗)42例和观察组(加用替诺福韦治疗)50例,比较两组乙肝病毒的脱氧核糖核酸(HBV-DNA)阴性率、MELD评分、炎症因子水平、肝功能及疗效。结果观察组患者治疗效果高于常规组患者,P<0.05;观察组治疗后总胆红素和谷丙氨酸氨基转移酶水平为(70.4±22.6)μmol/L和(64.5±34.5)U/L,均低于常规组的(114.7±31.6)μmol/L和(127.6±54.4)U/L(P<0.05);观察组治疗后高迁移率族蛋白B1、白介素-1β、血清单核细胞趋化蛋白-1水平分别为(59.3±3.8)ng/L、(45.2±3.8)ng/L及(13.5±1.1)μg/L,均低于常规组(P<0.05);观察组MELD评分(9.8±1.4)分,低于常规组(P<0.05);观察组HBV-DNA阴性率(92.1%)高于常规组(76.2%)(P<0.05)。结论恩替卡韦与替诺福韦的联合使用能够有效改善患者肝脏功能,同时能够抑制患者肝炎病毒的复制,值得临床广泛应用。Objective To analyze the effects of entecavir combined with tenofovir on MELD score and liver func⁃tion changes in patients with hepatitis B liver failure.Methods A total of 92 patients with hepatitis B liver fail⁃ure who received treatment in the First Affiliated Hospital of Zhengzhou University from December 2020 to De⁃cember 2021 were selected as the research object,and were divided into the conventional group 42 patients and the observation group 50 patients according to different drug use.The conventional group received entecavir cap⁃sule treatment,and the observation group received tenofovir combined with entecavir treatment.The treatment effect,changes of liver function indexes,levels of inflammatory factors,MELD score and negative rate of HBV-DNA were compared between the two groups.Results The treatment effect of observation group was higher than that of conventional group,P<0.05;After treatment,the levels of total bilirubin and glutalanine amin⁃otransferase in observation group were(70.4±22.6)μmol/L and(64.5±34.5)U/L,which were lower than those of conventional group(114.7±31.6)μmol/L and(127.6±54.4)U/L(P<0.05).After treatment,the levels of high mobility group protein B1,interleukin-1βand monocyte chemoattractant protein-1 in the observation group were(59.3±3.8)ng/L,(45.2±3.8)ng/L and(13.5±1.1)μg/L,respectively,which were lower than those of the conventional group(P<0.05).The MELD score of observa⁃tion group was(9.8±1.4),which was lower than that of conventional group(P<0.05).The negative rate of HBV-DNA in observation group(92.1%)was higher than that of conventional group(76.2%)(P<0.05).Conclusion The combination of entecavir and tenofovir can effectively improve the liver function of patients,and inhibit the complexity of hepatitis virus in patients,which is worthy of widespread clinical appli⁃cation.

关 键 词：恩替卡韦 替诺福韦 乙型肝炎 肝衰竭 终末期肝病的严重程度评分 肝功能变化 

分 类 号：R575.3[医药卫生—消化系统]