替诺福韦联合水飞蓟宾治疗乙肝肝硬化的临床研究  

Clinical study of tenofovir combined with silybin in the treatment of hepatitis B cirrhosis

作　　者：陈娴 蔡炳冈 CHEN Xian;CAI Bing-gang(Department of Infectious Diseases,Yancheng First People's Hospital,Yancheng 224000,China)

机构地区：[1]盐城市第一人民医院感染性疾病科,224000

出　　处：《中国实用医药》2024年第4期111-114,共4页China Practical Medicine

摘　　要：目的分析替诺福韦联合水飞蓟宾治疗乙型肝炎(乙肝)肝硬化的临床效果。方法选出86例乙肝肝硬化患者,依照不同用药方案分成A组(43例)与B组(43例)。A组采用替诺福韦治疗,B组采用替诺福韦联合水飞蓟宾治疗。比较两组肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)]、肝纤维化指标[Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽氨基末端肽(PⅢNP)、层粘连蛋白(LN)、透明质酸(HA)]、Child-Pugh评分、临床疗效、不良反应发生情况。结果B组用药后的ALT、AST、TBIL分别为(36.57±6.57)U/L、(30.93±4.87)U/L、(20.66±2.30)μmol/L,均低于A组的(50.12±7.20)U/L、(42.76±5.53)U/L、(29.83±2.89)μmol/L(P<0.05)。B组用药后的CⅣ、PⅢNP、LN、HA分别为(65.77±20.53)、(115.93±34.51)、(85.61±24.28)、(104.93±32.15)μg/L,低于A组的(92.52±27.28)、(143.76±45.40)、(107.54±32.73)、(152.34±41.72)μg/L(P<0.05)。A组用药前的Child-Pugh评分为(8.66±1.54)分,用药后为(6.92±1.36)分;B组用药前的Child-Pugh评分为(8.70±1.51)分,用药后为(5.73±1.10)分。两组用药前Child-Pugh评分无差异(P>0.05);B组用药后的Child-Pugh评分低于A组(P<0.05)。A组总有效率为79.07%(34/43),B组总有效率为95.35%(41/43);B组的总有效率高于A组(P<0.05)。两组的不良反应总发生率相近(P>0.05)。结论替诺福韦联合水飞蓟宾治疗乙肝肝硬化的效果较好,可以显著改善患者的肝功能指标与肝纤维化指标,有助于患者病情的良好控制,总有效率高,且与单纯采用替诺福韦治疗相比不增加不良反应,有效性与安全性均较好,可采纳、推行。Objective To analyze the clinical effect of tenofovir combined with silybin in the treatment of hepatitis B cirrhosis.Methods 86 patients with hepatitis B cirrhosis were divided into group A(43 cases)and group B(43 cases)according to different medication regimens.Group A was treated with tenofovir,and group B was treated with tenofovir and silybin.Comparison was made on liver function indicators[alanine aminotrasferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL)],liver fibrosis indicators[typeⅣcollagen(CⅣ),amino-terminal peptide of typeⅢprocollagen(PⅢNP),laminin(LN),hyaluronic acid(HA)],Child-Pugh score,clinical efficacy,and occurrence of adverse reactions between the two groups.Results After medication,ALT,AST and TBIL of group B were(36.57±6.57)U/L,(30.93±4.87)U/L and(20.66±2.30)μmol/L,which were lower than(50.12±7.20)U/L,(42.76±5.53)U/L and(29.83±2.89)μmol/L in group A(P<0.05).After medication,CⅣ,PⅢNP,LN and HA in group B were(65.77±20.53),(115.93±34.51),(85.61±24.28)and(104.93±32.15)μg/L,which were lower than(92.52±27.28),(143.76±45.40),(107.54±32.73)and(152.34±41.72)μg/L in group A(P<0.05).The Child-Pugh score of group A was(8.66±1.54)points before medication,and(6.92±1.36)points after medication.The Child-Pugh score of group B was(8.70±1.51)points before medication,and(5.73±1.10)points after medication.Before medication,there was no difference in Child-Pugh scores between the two groups(P>0.05).After medication,the Child-Pugh score of group B was lower than that of group A(P<0.05).The total effective rate was 79.07%(34/43)in group A and 95.35%(41/43)in group B.The total effective rate of group B was higher than that of group A(P<0.05).The total incidence of adverse reactions was similar between the two groups(P>0.05).Conclusion Tenofovir combined with silybin has a good effect in the treatment of hepatitis B cirrhosis,which can significantly improve the liver function indicators and liver fibrosis indicators of patients,contribute to the good control of patients'

关 键 词：替诺福韦 水飞蓟宾 乙型肝炎肝硬化 肝功能 肝纤维化 CHILD-PUGH评分 

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