摘要
目的观察使用阿德福韦酯联合双环醇治疗对HBeAg阴性CHB患者治疗前后HBV-DNA的表达水平、肝功能、HBsAg水平及外周血T淋巴细胞亚群间的关系及相关性的影响。方法87例HBeAg阴性CHB患者,随机分成阿德福韦酯组(对照组)和阿德福韦酯联合双环醇组(观察组),照组予口服阿德福韦酯10 mg/d,观察组在口服阿德福韦酯的基础上加服双环醇,疗程共48w,分别于12、24、48w随访并检测肝功能、HBV-DNA、HBsAg、外周血T淋巴细胞亚群变化情况并评价其相互间关系。结果与治疗前相比,两组各随访点肝功能均有好转,差异有统计学意义,第12w肝功能恢复观察组优于对照组;与治疗前相比,两组各随访点HBV-DNA、HBsAg均有改善,差异有统计学意义,且在第12w、24w HBV-DNA、HBsAg指标观察组优于对照组;与治疗前相比,两组第24、48w淋巴细胞亚群中CD8+、CD4+/CD8+差异有统计学意义,且在第24w CD8+、CD4+/CD8+两组间差异有统计学意义;治疗前后血清HBV-DNA载量与AST、ALT水平均正相关性,差异有统计学意义;治疗前后血清HBV-DNA水平与CD8+之间正相关。 HBV-DNA水平与CD4+/CD8+负相关。治疗前后血清HBV-DNA水平与HBsAg定量正相关性。结论阿德福韦酯联合双环醇片治疗HBeAg阴性的CHB,比单用阿德福韦酯能更快的改善临床症状,动态HBV-DNA定量监测可作为监测HBeAg阴性的CHB疗效的有效标记。
Objective To observe the influence and the correlation of HBV-DNA levels,liver function,HBsAg levels and peripheral blood T lymphocyte subsets with the therapy of adefovir ester and bicyclol in HBeAg negative expression of CHB patients before and after the treatment.Methods 87 cases of HBeAg negative CHB,randomly divided into adefovir ester group(control group)and joint bicyclol adefovir ester group(observation group),patients in control group take adefovir ester,and observing group take bicyclol and adefovir ester,period of treatment,a total of 48 weeks.Respectively,at 12,24 and 48 weeks follow-up and detection of liver function and HBV DNA levels,HBsAg level,the change of peripheral blood T lymphocyte subsets and evaluate the relationship between each other.Results Compared with before treatment,the fol ow-up points of two groups of liver function were improved,in weeks 12 the liver function recovery is bet er than the control group;Compared with before treatment,the fol ow-up points HBV-DNA and HBsAg of two groups were improved,and in weeks 12,24,the HBV-DNA and HBsAg index in the observation group is better than the control group;Compared with before treatment,the dif erence of lymphocyte subgroup of CD8+,CD4+/CD8+in two groups of 24 and 48 weeks were statistical y significant,and in 24 weeks CD8+,CD4+/CD8+were statistically significant dif erence between the two groups;Before and after treatment the serum HBV-DNA load and AST,ALT levels are positive correlation;The serum HBV-DNA level have positive correlation with CD8+,and have negative correlation with CD4+/CD8+.The serum HBV-DNA levels and HBsAg have quantitative positive correlation.Conclusion Taking Adefovir ester with bicyclol tablet in the treatment of HBeAg negative CHB can improve clinical symptoms faster than take adefovir ester alone,dynamic HBV-DNA quantitative monitoring can be used for ef ective monitoring the CHB efficacy of HBeAg negative markers.
作者
任毅英
REN Yi-ying(Department of Infectious Disease,The Affiliated Jiangyin Hospital of Southeast University Medical College,Jiangyin 214400,Jiangsu,China)
