恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎的临床疗效和远期结局  

Clinical efficacy and long-term outcome study of entecavir combined with compound Biejia Ruangan tablets in the treatment of patients with chronic hepatitis B

作　　者：龚红梅 李世炼 伍艺 毛青 夏杰 蒋黎 GONG Hongmei;LI Shilian;WU Yi;MAO Qing;XIA Jie;JIANG Li(The First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院感染病科,重庆400038

出　　处：《安徽医药》2024年第11期2301-2306,共6页Anhui Medical and Pharmaceutical Journal

基　　金：国家科技重大专项(2018ZX10725-506-001-002,2017ZX10202201-004-010)。

摘　　要：目的探讨应用恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎(CHB)的临床疗效。方法选取2013年5月至2015年4月陆军军医大学第一附属医院收治的120例CHB病人为研究对象,其中联合组应用恩替卡韦(ETV)联合复方鳖甲软肝片治疗60例,对照组应用ETV治疗60例,均治疗72周。随后两组继续服用ETV,随访至少8年。观察两组病人治疗72周的疗效、两次肝活检组织病理学的变化以及分析逆转肝组织纤维化的相关因素,统计两组随访8年的肝癌发生率和病死率。结果治疗72周,联合组肝脏硬度测量值(LSM)下降率58.333%与对照组28.333%相比,差异有统计学意义(P<0.05)。接受两次肝穿的CHB病人,联合组肝纤维化逆转率78.000%与对照组48.485%相比,差异有统计学意义(P<0.05)。单因素分析结果显示,年龄和纤维化分期(F)与肝组织纤维化逆转有关(P<0.05)。多因素分析结果显示,年龄和纤维化分期(F)是肝组织纤维化逆转的独立保护因素(P<0.05)。经过长达8年以上的随访,联合组肝癌发生率和肝脏相关病死率与对照组比较,差异无统计学意义(P>0.05)。结论ETV联合复方鳖甲软肝片治疗72周可显著降低CHB病人的LSM值,逆转进展期肝纤维化。早期抗病毒联合抗纤维化治疗对逆转肝纤维化有重要意义,或可影响长期抗病毒治疗的远期结局。Objective To evaluate the clinical efficacy of entecavir combined with compound Biejia Ruangan tablets in the treatment of patients with chronic hepatitis B(CHB).Methods A total of 120 CHB patients admitted to the First Affiliated Hospital of Army Medical University from May 2013 to April 2015 were selected as the study objects.Sixty cases in the combination group were treated with entecavir(ETV)combined with compound Biejia Ruangan tablets,and 60 cases in the control group were treated with ETV for 72 weeks.Subsequently,both groups continued to take ETV and were followed up for at least 8 years.The curative effect of 72 weeks treatment,pathological observation of two liver biopsies and related factors affecting the reversal of liver fibrosis were compared between the two groups.The incidence and mortality of liver cancer in the two groups were analyzed after 8 years of follow-up.Results After 72 weeks of treatment,the decrease rate of liver hardness measurement(LSM)in the combined group was 58.333%,which was significantly higher than 28.333%in the control group(P<0.05).In CHB patients who received two liver perforations,the liver fibrosis reversal rate in the combined group was 78.000%,which was significantly higher than 48.485%in the control group(P<0.05).Univariate analysis showed that age and fibrosis stage(F)were associated with the reversal of liver fibrosis(P<0.05).The results of multifactor analysis showed that age and fibrosis stage(F)were independent protective factors for liver fibrosis reversal(P<0.05).After more than 8 years of follow-up,there was no significant difference in the incidence of liver cancer and liver-related mortality between the combined group and the control group(P>0.05).Conclusions The administration of entecavir combined with compound Biejia Ruangan tablets in the treatment of patients with CHB could reduce LSM values and reverses the progression of liver fibrosis.Early combination therapy is of great significance for the reversal of liver fibrosis and may influence the long-term

关 键 词：乙型肝炎 慢性 抗病毒治疗 肝纤维化 复方鳖甲软肝片 恩替卡韦 

分 类 号：R512.62[医药卫生—内科学]