肝穿刺活检术评估下不同病情慢性乙型肝炎患者经恩替卡韦治疗的临床疗效  

Clinical efficacy of entecavir therapy and changes in liver function in patients with different degrees of inflammatory activity and liver fibrosis after liver puncture biopsy

作　　者：江启贵 朱艳 刘晓玲[1] 赵阳洋[1] JIANG Qigui;ZHU Yan;LIU Xiaoling;ZHAO Yangyang(Department of Infectious Diseases,Chizhou People's Hospital,Chizhou 247100,Anhui,China)

机构地区：[1]池州市人民医院感染性疾病科,安徽池州247100

出　　处：《西部医学》2024年第3期443-446,453,共5页Medical Journal of West China

摘　　要：目的 探讨肝穿刺活检术下不同炎症活动度及肝纤维化程度慢性乙型肝炎(Chronic hepatitis B,CHB)患者采用恩替卡韦治疗的临床疗效分析。方法 回顾性分析2015年6月—2020年6月我院收治的80例CHB患者临床资料,患者治疗前均进行肝穿刺活检术,随后接受恩替卡韦治疗48周,比较不同炎症活动度(G1~G4级)与肝纤维化程度(S0~S4期)患者治疗效果及治疗前后肝功能(ALT、AST、TBiL)水平情况。结果 根据病理结果显示,纤维化S0期46例、 S1期19例、S2期7例、S3期7例、S4期1例;炎症活动度患者中G1级45例、G2级24例、G3级11例、G4级0例。不同纤维化与炎症分化程度患者治疗48周时临床总有效率比较,差异有统计学意义(P<0.05)。重复测量方差分析显示,不同肝组织纤维化患者,肝功能(ALT、AST、TBiL)在时点因素、时点交互因素、组别因素中均有统计学差异(P<0.05);与治疗前比较,治疗后不同肝组织纤维化分级患者肝功能得到显著下降(P<0.05)。不同炎症分化程度患者,ALT指标在时点因素、时点交互因素、组别因素中均有统计学差异(P<0.05);AST、TBiL指标仅在时点因素中有统计学差异(P<0.05);治疗后不同炎症分化程度患者肝功能指标与治疗前比较,差异均具有统计学意义(P<0.05)。结论 肝穿刺活检术可了解CHB患者炎症分化程度与纤维化程度,炎症分化程度越高其纤维化程度越高,采用恩替卡韦治疗后炎症分化程度与纤维化程度分级越高患者预后相对较差,但可显著改善肝功能情况。Objective To analyze the effect of entecavir on chronic hepatitis B patients with different degrees of inflammatory activity and liver fibrosis.Methods 80 patients with chronic hepatitis B treated in our hospital from June 2015 to June 2020 were retrospectively analyzed.All patients underwent liver biopsy before treatment,and then received entecavir treatment for 48 weeks.The clinical therapeutic effect and liver function changes of patients with different degrees of inflammatory activity and liver fibrosis after liver biopsy were analyzed.Results According to the pathological results,there were 46 cases of fibrosis S0,19 cases of S1,7 cases of S2,7 cases of S3 and 1 case of S4;45 cases of G1,24 cases of G2,11 cases of G3 and 0 of G4 grade were of inflammatory activity.The curative effect of patients with different degree of fibrosis and inflammatory differentiation after 48 weeks of treatment(P<0.05).The liver function of patients with different liver tissue fibrosis was in time point factor,time point interaction factor and group factor(P<0.05).After treatment,liver function of patients with different liver tissue fibrosis grade was significantly decreased compared with that before treatment(P<0.05).In patients with different degree of inflammatory differentiation,ALT index was in time point factor,time point interaction factor and group factor(P<0.05).AST and TBIL index were only in time point factor(P<0.05).Liver function indexes of patients with different degree of inflammatory differentiation after treatment were significantly different from those before treatment(P<0.05).Conclusion Liver biopsy can understand the degree of inflammatory differentiation and fibrosis in patients with chronic hepatitis B.The higher the degree of inflammatory differentiation and the higher the degree of fibrosis.However,after entecavir treatment,the higher the degree of inflammatory differentiation and fibrosis,the worse the prognosis of patients,but it can significantly improve the liver function.

关 键 词：肝穿刺活检 慢性乙型肝炎 炎症活动度 肝纤维化 恩替卡韦 治疗效果 

分 类 号：R512.62[医药卫生—内科学]