摘要
目的观察替比夫定与恩替卡韦分别联合阿德福韦酯治疗对慢性乙型肝炎(CHB)患者肝功能、肝纤维化指标、HBV-DNA水平及不良反应的影响。方法选取304例CHB患者,随机分成2组,每组152例,对照组替比夫定(600mg/d)+阿德福韦酯(10mg/d)治疗,观察组恩替卡韦(0.5 mg/d)+阿德福韦酯(10mg/d)治疗,两组疗程均为48周,比较两组肝功能、肝纤维化指标、HBV-DNA水平及不良反应发生情况。结果两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)以及Child-Pugh评分均较治疗前显著下降(P <0. 05),且观察组变化幅度大于对照组(P<0.05);两组总蛋白(TP)、白蛋白(ALB)、凝血酶原活动度(PTA)均较治疗前显著上升(P<0.05),且观察组升高幅度大于对照组(P <0. 05);两组透明质酸酶(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、IV型胶原(IV-C)、脯肽酶(PLD)均较治疗前显著降低(P<0.05),且观察组降低幅度大于对照组(P<0.05);两组HBVDNA转阴率和HBeAg血清学转换率均较治疗前显著升高(P<0.05),且观察组升高幅度大于对照组(P<0.05)。结论恩替卡韦+阿德福韦酯治疗CHB的疗效优于替比夫定+阿德福韦酯,患者肝功能恢复快,HBV DNA转阴率和HBe Ag血清学转换率高,安全性好,不良反应少,值得在临床推广。
Objective To observe the effects of telbivudine or entecavir combined with adefovir dipivoxil on liver function,hepatic fibrosis indexes,HBV-DNA level and adverse reactions in patients with chronic hepatitis B (CHB ).Methods 304 cases of CHB patients were selected and randomly divided into two groups (each n=152).The control group was given 600 mg/d telbivudine and 10 mg/d adefovir dipivoxil,while the observation group was given 0.5 mg/d entecavir and 10 mg/d adefovir dipivoxil.The two groups were treated for 48 weeks.The liver function,hepatic fibrosis indexes,HBV-DNA level and adverse reactions were analysed in the two groups after 48 weeks of treatment.Results The levels of alanine transamlnase (ALT) and aspartate aminotransferase (AST),alkaline phosphatase (ALP) and total bilirubin (TBIL) and the score of Child-Pugh decreased significantly compared with those before treatment (P<0.05),and the change degree in the observation group after treatment was higher than that in the control group (P<0.05).The levels of total protein (TP),albumin (ALB),and prothrombin activity (PTA) in the two groups were significantly higher than those before treatment (P<0.05),and the change degree in the observation group after treatment was higher than that in the control group (P<0.05).The levels of hyaluronidase (HA),laminin (LN),procollagen Ⅲ (PCⅢ),collagen type Ⅳ (Ⅳ-C)and prolidase (PLD) in the two groups were significantly lower than those before treatment(P<0.05),and the change degree in the observation group after treatment was higher than that in the control group (P<0.05).The DNA negative rate of HBV and the seroconversion rate of HBeAg in the two groups were significantly higher than those before treatment (P<0.05),and the change degree in the observation group after treatment was higher than that in the control group(P<0.05). Conclusion Entecavir and adefovir dipivoxil can have better efficacy than telbivudine and adefovir dipivoxil in the treatment of CHB,the former one can have faster recovery of liver function,higher DNA negative rate of HBV and seroconversion rate of HBeAg,and have better safety and fewer adverse reactions,therefore the former one is worthy of clinical promotion.
作者
张丽丽
马欢
杨建波
罗玉君
ZHANG Li-li;MA Huan;YANG Jian-bo;LUO Yu-jun(Department of Gastroenterology,Mianyang Central Hospital,Mianyang 621000,China)
出处
《标记免疫分析与临床》
CAS
2018年第11期1615-1618,1622,共5页
Labeled Immunoassays and Clinical Medicine
基金
四川省医学会基金项目(编号:2017SZJA11)
作者简介
张丽丽(1984-),女,硕士研究生,主治医师。研究方向:肝纤维化的发生机制与防治。Tel:13778108273;E-mail:m29773317yohao586@163.com;通讯作者:罗玉君
