摘要
目的研究替诺福韦酯联合鳖甲煎丸对乙型肝炎肝硬化的疗效。方法选取2015年1月至2018年1月湛江中心人民医院收治的186例乙型肝炎肝硬化患者进行前瞻性研究,采用随机抽签法平均分成试验组和对照组,每组93例。对照组予以替诺福韦酯(300 mg/d)治疗,试验组在对照组的基础上加用鳖甲煎丸(口服,3 g/次,3次/d)治疗,均连续治疗12个月。比较两组治疗前后天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血清白蛋白(albumin,ALB)、总胆红素(total bilirubin,TBil)、透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)、Ⅳ型胶原(typeⅣcollagen,Ⅳ-C)、Ⅲ型前胶原(typeⅢprocollagen,PCⅢ)、血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、肝癌发病率及病死率的差异。结果治疗12个月后,试验组AST [(65.17±12.39)U/L vs(97.05±18.63)U/L]、ALT [(70.31±11.38)U/L vs(106.83±14.38)U/L]、TBil [(27.30±4.21)μmol/L vs(48.16±6.08)μmol/L]、HA [(102.75±15.44)mg/L vs(152.46±17.08)mg/L]、LN [(100.88±16.32)μg/ml vs(153.72±17.07)μg/ml]、Ⅳ-C [(95.32±11.74)μg/L vs(122.59±13.18)μg/L]、PCⅢ[(100.14±12.56)μg/L vs(152.98±15.41)μg/L]、CRP [(3.28±1.56)mg/L vs(5.11±2.04)mg/L]、TNF-α[(22.17±8.01)μg/L vs(31.95±8.23)μg/L]及IL-1β[(6.57±1.47)ng/L vs(10.18±3.01)ng/L]均显著低于对照组(P均<0.05),而ALB[(38.92±4.37)g/L vs(33.65±3.84)g/L]水平显著高于对照组(t=8.726,P <0.001)。试验组患者肝癌发病率为3.23%(3/93),病死率为2.15%(2/93),对照组患者肝癌发病率为4.30%(4/93),病死率为3.23%(3/93),差异均无统计学意义(χ2=0.148、0.206,P=0.700、0.650)。结论替诺福韦酯联合鳖甲煎丸治疗乙型肝炎肝硬化的疗效显著,有利于改善患者的纤维化指标及炎症反应。
Objective To investigate the curative effects of tenofovir dipivoxil combined with Biejiajian pill on hepatitis B related cirrhosis. Methods Total of 186 cases with hepatitis B related cirrhosis in Zhanjiang Central People’s Hospital from January 2015 to January 2018 were selected in this perspective study. The patients were divided into experimental group and control group by random lottery, 93 cases in each group. Patients in control group were treated with tenofovir disoproxil(300 mg/d) and patients in experimental group were treated with Biejiajian pill(3 g per time, 3 times/d, orally) on the basis of control group, the cours was 12 months. Aspartate aminotransferase(AST), alanine aminotransferase(ALT), albumin(ALB), total bilirubin(TBil), hyaluronic acid(HA), laminin(LN), type Ⅳ collagen(Ⅳ-C), type Ⅲ procollagen(PCⅢ), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), the incidence of liver cancer and mortality of patients in two groups were compared before and after treatment. Results After treatment for 12 months, the levels of AST [(65.17 ± 12.39) U/L vs(97.05 ± 18.63) U/L], ALT [(70.31 ± 11.38) U/L vs(106.83 ± 14.38) U/L], TBil [(27.30 ± 4.21) μmol/L vs(48.16 ± 6.08) μmol/L], HA [(102.75 ± 15.44) mg/L vs(152.46 ± 17.08) mg/L], LN [(100.88 ± 16.32) μg/ml vs(153.72 ± 17.07) μg/ml], Ⅳ-C [(95.32 ± 11.74) μg/L vs(122.59 ± 13.18) μg/L], PCⅢ [(100.14 ± 12.56) μg/L vs(152.98 ± 15.41) μg/L], CRP [(3.28 ± 1.56) mg/L vs(5.11 ± 2.04) mg/L], TNF-α [(22.17 ± 8.01) μg/L vs(31.95 ± 8.23) μg/L] and IL-1β [(6.57 ± 1.47) ng/L vs(10.18 ± 3.01) ng/L] of patients in experimental group were significantly lower than those in control group(all P < 0.05), the ALB level of patients in experimental group was significantly higher than that in control group(t = 8.726, P < 0.001). The incidence of liver cancer and mortality of patients in experimental group were 3.23%(3/93) and 2.15%(2/93), respectively, which were 4.30%(4/93) and 3.23%(3/93) in control group, respectively, and the differences were not statistically significant(χ2 = 0.148, 0.206;P = 0.700, 0.650). Conclusions Tenofovir disoproxil combined with Biejiajian pill has a significant curative effect on the treatment of hepatitis B related cirrhosis, which is helpful to improve the level of fibrosis indexes and inflammatory response of the patients.
作者
马燕妮
陈勇军
庄银安
Ma Yanni;Chen Yongjun;Zhuang Yin’an(Department of Infectious Diseases,Zhanjiang Central People’s Hospital,Zhanjiang 524000,Guangdong Province,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2020年第1期19-23,共5页
Chinese Journal of Liver Diseases：Electronic Version
关键词
乙型肝炎肝硬化
替诺福韦酯
鳖甲煎丸
肝纤维化指标
炎症指标
Hepatitis B related cirrhosis
Tenofovir disoproxil
Biejiajian pill
Fibrosis index
Inflammatory biomarkers
作者简介
通讯作者:马燕妮,Email:zjmyn_118@163.com。
