富马酸丙酚替诺福韦与恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者效果比较研究  

Intestinal barrier function index changes in patients with compensated hepatitis B cirrhosis and high serum viral loads undergoing tenofovir alafenamide fumarate or entecavir therapy

作　　者：李双玲[1] 刘丽 陈艺 李坤[1] Li Shuangling;Liu Li;Chen Yi(Department of Gastroenterology,Qianfoshan Hospital,Affiliated to Shandong First Medical University,Jinan 250014,Shandong Province,China)

机构地区：[1]山东第一医科大学第一附属医院/山东省千佛山医院消化内科,济南市250014 [2]山东医学高等专科学校医学系

出　　处：《实用肝脏病杂志》2024年第5期749-752,共4页Journal of Practical Hepatology

基　　金：山东省医学会临床科研齐鲁专项资金资助项目(编号:YXH2022ZX02113)。

摘　　要：目的分析比较富马酸丙酚替诺福韦与恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者的疗效。方法2020年1月~2023年1月我院收治的64例高血清病毒载量(HBVDNA为1×106 IU/mL或以上)的代偿期乙型肝炎肝硬化患者,被随机分为对照组32例和观察组32例,分别给予恩替卡韦和富马酸丙酚替诺福韦治疗,连续治疗观察12个月。使用高效液相色谱分析法检测尿液乳果糖/甘露醇(L/M)比值,采用比色法检测血清D-乳酸,采用紫外比色法检测血清二胺氧化酶(DAO),采用ELISA法检测血清内霉素和白细胞介素-7(IL-7),采用化学发光免疫分析法检测血清降钙素原(PCT),采用免疫荧光定量法检测肝素结合蛋白(HBP)。结果在观察治疗12个月末,两组均获得病毒学和生化学应答,两组血清TBIL、ALT和AST水平无显著性相差(P>0.05);观察组血清DAO、D-乳酸、内霉素和尿L/M比值分别为(2.8±0.6)U/mL、(7.9±1.8)μg/mL、(0.5±0.1)EU/mL和(7.3±1.6)%,与对照组【分别为(3.0±0.5)U/mL、(7.8±2.2)μg/mL、(0.6±0.1)EU/mL和(8.1±1.9)%,P>0.05】比,无显著性差异;观察组血清PCT、HBP和IL-7水平分别为(0.01±0.00)μg/L、(43.1±3.7)ng/mL和(768.9±20.3)pg/mL,与对照组【分别为(0.02±0.01)μg/L、(47.6±3.2)ng/mL和(743.4±21.5)pg/mL,P>0.05】比,无显著性差异。结论应用富马酸丙酚替诺福韦或恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者疗效肯定,对肠道屏障功能无明显的影响。Objective The aim of this study was to investigate intestinal barrier function index changes in patients with compensated hepatitis B liver cirrhosis(LC)and high serum viral loads undergoing tenofovir alafenamide fumarate(TAF)or entecavir(ETV)therapy.Methods 64 patients with compensated hepatitis B-induced LC and high serum viral loads(HBVDNAswere 1equal to or greater than×10^(6)IU/mL)were enrolled in our hospital between January 2020 and January 2023,and we randomly assigned them to receive TAF(observation,n=32)or to ETV(control,n=32)therapy.The regimen continued and antiviral efficacy was assessed by end of 12 months.Urine lactulose/mannitol(L/M)ratio was detected by high performance liquid chromatography.Serum D-lactic acid was measured by colorimetry,serum diamine oxidase(DAO)by ultraviolet colorimetry,and serum endotoxin and interleukin-7(IL-7)levels was assayed by EIISA.Serum procalcitonin(PCT)level was determined by chemiluminescence immunoassay,and heparin-binding protein(HBP)level was detected by immunofluorescence quantitative method.Results By end of 12-month antiviral treatment,complete virological and biochemical responses were obtained in the two groups,and there were no significant differences as respect to serum bilirubin,ALT and AST levels in the two groups(P>0.05);serum DAO,D-lactic acid,endotoxin and urine L/M ratio in the observation group were(2.8±0.6)U/mL,(7.9±1.8)μg/mL,(0.5±0.1)EU/mL and(7.3±1.6)%,all not significantly different compared to[(3.0±0.5)U/mL,(7.8±2.2)μg/mL,(0.6±0.1)EU/mL and(8.1±1.9)%,respectively,P>0.05]in the control;serum PCT,HBP and IL-7 levels were(0.01±0.00)μg/L,(43.1±3.7)ng/mL and(768.9±20.3)pg/mL,also not significantly different as compared to[(0.02±0.01)μg/L,(47.6±3.2)ng/mL and(743.4±21.5)pg/mL,respectively,P>0.05]in the control groups.Conclusion Both TAF or ETV has a satisfactory antiviral efficacy in treatment of patients with compensated hepatitis B-induced LC,without intestinal barrier function damage.

关 键 词：肝硬化 乙型肝炎 富马酸丙酚替诺福韦 恩替卡韦 高病毒载量 肠道屏障功能 治疗 

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