| 程辉,袁宇慧.不同核苷(酸)类抗病毒药物在失代偿期乙型肝炎肝硬化患者治疗中的应用[J].安徽医药,2016,20(12):2327-2330. |
| 不同核苷(酸)类抗病毒药物在失代偿期乙型肝炎肝硬化患者治疗中的应用 |
| Application of different nucleoside antiviral drugs in patients with HBV-related decompensated hepatic cirrhosis |
| 投稿时间：2016-08-09 |
| DOI： |
| 中文关键词: 乙型肝炎肝硬化 失代偿期 肝功能 肾功能 核苷(酸)类抗病毒药物 |
| 英文关键词: HBV-related hepatic cirrhosis Decompensated period Liver function Kidney function Nucleoside antiviral drug |
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| 中文摘要: |
| 目的 探讨不同核苷(酸)类抗病毒药物在失代偿期乙型肝炎肝硬化患者治疗中的应用。方法 选择失代偿期乙型肝炎肝硬化患者136例,按随机数字表法将其分为拉米夫定组(46例)、阿德福韦酯组(45例)和联合治疗组(45例)。3组患者均护肝和对症支持基础治疗,拉米夫定组给予拉米夫定治疗,阿德福韦酯组给予阿德福韦酯,联合治疗组给予拉米夫定和阿德福韦酯治疗。治疗52周后,观察各组患者的肝功能指标变化、肝纤维化指标变化、病毒复制情况、肝功能恢复情况以及肾功能损伤情况。结果 与治疗前比较,治疗52周后3组患者的天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)水平均显著下降,而清蛋白(ALB)、胆碱酯酶(CHE)水平显著上升,差异有统计学意义(P＜0.05)；治疗后联合治疗组患者的AST、ALT、TBil水平显著低于拉米夫定组和阿德福韦酯组,ALB、CHE水平显著高于拉米夫定组和阿德福韦酯组,差异有统计学意义(P＜0.05)；3组患者的HBV-DNA拷贝数均较治疗前显著降低,且联合治疗组＜拉米夫定组＜阿德福韦酯组,差异有统计学意义(P＜0.05)；治疗后3组患者的透明质酸酶(HA)、Ⅲ型前胶原(PCⅢ)和层粘连蛋白(LN)水平均显著下降,差异有统计学意义(P＜0.05)；阿德福韦酯组治疗后患者肌酐(Cr)水平显著上升(P＜0.05),其余两组Cr、尿素氮(BUN)水平和肾小球滤过率(eGFR)均差异无统计学意义(P＞0.05)。与拉米夫定组和阿德福韦酯组比较,联合治疗组ALT复常率、HBV-DNA转阴率、耐药性均差异有统计学意义(P＜0.05),但阿德福韦组和拉米夫定组在ALT复常率、HBV-DNA转阴率、耐药性方面比较,差异无统计学意义(P＞0.05)。结论 对失代偿期乙型肝炎肝硬化患者给予不同核苷(酸)类抗病毒药物进行抗病毒治疗,均可不同程度地改善患者的肝功能、肝硬化程度,且联合用药抗病毒效果更佳。 |
| 英文摘要: |
| Objective To explore the application of different nucleoside antiviral drugs in patients with HBV-related decompensated hepatic cirrhosis.Methods A total of 136 patients with HBV-related decompensated hepatic cirrhosis were selected and randomized into lamivudine group (n=46),adefovir dipivoxil group (n=45) and combined group (n=45).Three groups were all treated based on liver protection and symptomatic support treatment.Lamivudine group was treated with lamivudine,adefovir dipivoxil group with adefovir dipivoxil,and combined group with lamivudine and adefovir dipivoxil.After treatment of 52 weeks,the liver function indexes,liver fibrosis indexes,viral replication,liver function recovery and kidney damage condition were observed in each group.Results Compared with those before treatment,the levels of aspartate aminotransferase (AST),alanine aminotransferase (ALT),and total bilirubin (TBil) decreased obviously,while the levels of albumin (ALB) and cholinesterase (CHE) increased significantly in all three groups after 52-week treatment (P＜0.05).And the levels of AST,ALT and TBil in combined group were significantly lower than those in lamivudine group and adefovir dipivoxil group,and the levels of ALB and CHE were significantly higher than those in lamivudine group and adefovir dipivoxil group (P＜0.05). The HBV DNA copy number was lower significantly in three groups after treatment,which was the lowest in combined group,followed by lamivudine group and adefovir dipivoxil group (P＜0.05).The levels of hyaluronidase (HA),procollagen III (PCⅢ) and laminin (LN) was decreased significantly in all groups after treatment when compared with those before treatment (P＜0.05).The level of Cr in adefovir dipivoxil group significantly raised after treatment (P＜0.05),but in the other two groups the levels of Cr,BUN and eGFR were not different.Compared with lamivudine group and adefovir dipivoxil group,ALT normalizing rate,HBV-DNA negative conversion ratio,and tolerance in combined group had significant difference(P＜0.05),but there was no difference between lamivudine group and adefovir dipivoxil group regarding the above three indexes (P＞0.05).Conclusions Nucleoside antiviral drugs as antiviral therapy can improve the liver function and the degree of liver cirrhosis in patients with HBV-related decompensated hepatic cirrhosis.And the combined use of drugs has better antiviral effect. |
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