复方甘草酸苷联合替比夫定对阿德福韦酯耐药乙肝肝硬化患者肝纤维化及炎症指标的影响  

Effects of compound glycyrrhizin combined with telbivudine on liver fibrosis and inflammatory markers in patients with hepatitis b cirrhosis resistant to adefovir dipivoxil

作　　者：南鹏 歧红阳[2] 王志民[2] NAN Peng;QI Hongyang;WANG Zhimin(Department of Internal Medicine II,Xinxiang Infectious Disease Hospital,Xinxiang 453000,China;Department of Gastroenterology,Xinxiang Central Hospital,Xinxiang 453000,China)

机构地区：[1]新乡市传染病医院内科二病区,河南新乡453000 [2]新乡市中心医院消化内科,河南新乡453000

出　　处：《黑龙江医药科学》2025年第1期23-26,共4页Heilongjiang Medicine and Pharmacy

基　　金：河南省医学科技攻关联合共建项目,编号:LHGJ20221114。

摘　　要：目的:研究复方甘草酸苷联合替比夫定治疗阿德福韦酯耐药乙肝肝硬化的有效性及安全性。方法:选取新乡市传染病医院2021年8月至2023年7月收治的87例阿德福韦酯耐药乙肝肝硬化患者临床资料,进行回顾性研究,根据治疗方案分为两组,将采用替比夫定治疗的42例患者列为对照组,采用替比夫定联合复方甘草酸苷治疗的45例患者列为联合组。治疗6个月后,对比两组乙肝病毒脱氧核糖核酸(HBV-DNA)、肝功能指标[丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、白蛋白(ALB)]、肝纤维化指标[层黏连蛋白(LN)、前透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(Ⅳ-C)]、炎症指标[白细胞介素-6(IL-6)、IL-12、IL-18、肿瘤坏死因子α(TNF-α)]及不良反应。结果:治疗后两组HBV-DNA对比,差异无统计学意义(P>0.05);治疗后联合组ALT、γ-GT、TBIL分别为(39.35±5.08)U/L、(41.02±6.94)U/L、(19.60±2.64)μmoL/L,低于对照组的(50.62±8.05)U/L、(50.83±5.72)U/L、(28.73±3.05)μmoL/L,ALB(45.86±3.02)g/L高于对照组(36.92±4.05)g/L,差异有统计学意义(P<0.05);治疗后联合组LN、HA、PⅢP、Ⅳ-C分别为(90.64±10.23)μg/L、(89.60±5.42)μg/L、(106.37±20.60)μg/L、(85.31±10.09)μg/L,低于对照组的(110.06±15.64)μg/L、(108.82±8.07)μg/L、(131.54±23.87)μg/L、(101.02±13.55)μg/L,差异有统计学意义(P<0.05);治疗后联合组IL-6、IL-18、IL-22、TNF-α分别为(56.90±8.63)pg/mL、(130.08±20.62)pg/mL、(68.62±15.84)pg/mL、(0.34±0.13)μg/L,低于对照组的(79.64±10.57)pg/mL、(152.93±25.86)pg/mL、(92.37±10.09)pg/mL、(0.61±0.15)μg/L,差异有统计学意义(P<0.05);两组不良反应发生率(15.56%vs14.29%)对比,差异无统计学意义(P>0.05)。结论:复方甘草酸苷联合替比夫定治疗阿德福韦酯耐药乙肝肝硬化可改善肝功能及肝纤维化,抑制炎性反应,安全性较高。Objective:To investigate the efficacy and safety of compound glycyrrhizin combined with telbivudine in the treatment of hepatitis B cirrhosis resistant to adefovir dipivoxil.Methods:A retrospective study was conducted on the clinical data of 87 patients with hepatitis B cirrhosis resistant to adefovir dipivoxil treated at Xinxiang Infectious Disease Hospital from August 2021 to July 2023.Patients were divided into two groups based on the treatment approach:the control group consisting of 42 patients treated with telbivudine alone and the combined group consisting of 45 patients treated with telbivudine combined with compound glycyrrhizin.After 6 months of treatment,hepatitis B virus deoxyribonucleic acid(HBV-DNA),liver function indicators[alanine aminotransferase(ALT),gamma-glutamyltranspeptidase(γ-GT),total bilirubin(TBIL),albumin(ALB)],liver fibrosis markers[laminin(LN),hyaluronic acid(HA),type III procollagen peptide(PⅢP),type IV collagen(Ⅳ-C)],inflammatory markers[interleukin-6(IL-6),IL-12,IL-18,tumor necrosis factor-α(TNF-α)],and adverse reactions were compared between the two groups.Results:There was no statistically significant difference in HBV-DNA levels between the two groups after treatment(P>0.05).After treatment,ALT,γ-GT and TBIL levels in the combined group were(39.35±5.08)U/L,(41.02±6.94)U/L and(19.60±2.64)μmoL/L,respectively,which were lower than those in the control group[(50.62±8.05)U/L,(50.83±5.72)U/L,and(28.73±3.05)μmoL/L,respectively],while ALB levels were higher in the combined group(45.86±3.02)g/L compared to the control group(36.92±4.05)g/L.These differences were statistically significant(P<0.05).After treatment,the levels of LN,HA,PⅢP andⅣ-C in the combined treatment group were(90.64±10.23)μg/L,(89.60±5.42)μg/L,(106.37±20.60)μg/L and(85.31±10.09)μg/L,respectively,which were lower than those in the control group at(110.06±15.64)μg/L,(108.82±8.07)μg/L,(131.54±23.87)μg/L and(101.02±13.55)μg/L,respectively.The differences were statistically significant(P<

关 键 词：复方甘草酸苷 替比夫定 阿德福韦酯 乙肝肝硬化 肝纤维化 白细胞介素 

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