摘要
目的:通过比较恩替卡韦(entecavir,ETV)单药和联合胸腺肽(thymosin,Thyα-a)对慢性乙肝肝纤维化患者APRI和LSM值的疗效,优化抗乙肝病毒治疗方案。方法:代偿期乙肝肝硬化患者72例,随机分为ETV组34例,ETV+Thyα-a组38例。ETV组给予ETV分散片,0.5mg/次,1次/日,疗程78周;ETV+Thyα-a组在服用ETV分散片的基础上,于26周后联合Thyα-a,1.6mg/次,2次/周,皮下注射,治疗52周,疗程78周。检测治疗前及治疗后26、52、78周患者血小板计数和天冬氨酸氨基转移酶活性,采用Fibro Touch超声诊断仪测定LSM值。结果 :两组患者的APRI均呈总体下降趋势,其中以0~26周下降最为明显,26、52、78周的APRI均低于0周,差异均有统计学意义(P<0.01)。两组APRI均呈总体下降趋势,均以0~26周下降最为明显;26、52、78周的APRI均低于0周,差异均有统计学意义(P<0.01);78周的LSM值低于26周,差异有统计学意义(P<0.05)。ETV+Thyα-a组患者的病毒定量呈总体下降趋势,26、52、78周病毒定量均低于0周,差异均有统计学意义(P<0.02)。而ETV组在0~26周下降明显,但在52周、78周逐渐升高。ETV组各访视点间的病毒定量差异均无统计学意义(P>0.05)。两组在同一访视点的病毒定量差异均无统计学意义(P>0.05)。结论:ETV单药和ETV+Thyα-a联合用药能在治疗26周内迅速降低代偿期乙肝肝硬化患者的APRI和LSM值,持续抗病毒治疗可将APRI、LSM值和病毒定量控制在较低水平,但是两种治疗方案间并无明显的疗效差异。
Objectives：The antiviral treatment regimen was optimized by comparing the efficacy of ETV and ETV combined with Thyα-a on patients with chronic hepatitis B accompanied by liver fibrosis which was reflected by the values of APRI,LSM and HBV-DNAin serums. Methods：A total of 72 patients in compensation period of hepatitis B cirrhosis at the outpatient department of Yanbian University Hospital from October 2013 to December 2014 were enrolled. They were divided randomly into two groups： 34 cases were for the ETV group and 38 cases for the ETV＋Thyα-a group. The patients in the ETV group received ETV dispersible tablets 2 hours after meal, at a dose of 0.5 mg each time, once daily, for 78 weeks. The patients in the ETV ＋Thyα-a group received ETV dispersible tablets as in the ETV group, and given combinedly with Thyα-a by subcutaneous injection after 26 weeks, at a dose of 1.6 mg each time, twice weekly, for 52 weeks.The total period of treatment also was 78 weeks. Before and after treatment with ETV or ETV＋ Thyα-a for 26, 52 and 78 weeks, APRI was calculated by tesing activity of aspartate aminotransferase and platelet counts in blood, and the value of LSM was determined by ultrasound diagnosis instrument Fibro Touch. Results：During the course of the treatment, 5 cases were lost to follow up including 2 cases at 26 weeks（1 was from the ETV group and 1 from the ETV＋Thyα-a group）, 1 case at 52 weeks（from the ETV＋Thyα-a group）, 2 cases at 78 weeks（from the ETV group）. The rest patients were received a complete treatment. The values of APRI in the ETV group and the ETV＋Thyα-a group both showed a trend of decrease, of which the most significant change was from 0 week to 26 weeks. The value of APRI at 0 week was higher than that of the others all time points（26, 52 and 78 weeks）（P〈0.01）. The values of LSM in two group both showed a trend of decline, of which the most significant change was from 0 week to 26 weeks. The value of LSM at 0 week was higher than those in other time points（26, 52 and 78 weeks）（P〈0.05）. Moreover, the value of LSM at 26 weeks was significantly higher than at 78weeks（P〈0.05）. The values of HBV-DNA in the ETV＋Thyα-agroupshowed atrend of decline,of which the most significant change was from 0 week to 26 weeks.The value of HBV-DNA at 0 week was higher than those in other time points（26, 52 and 78 weeks）（P〈0.05）.There was no significant difference in values of APRI, LSM and HBV-DNA between the ETV group and the ETV＋Thyα-a group（P〈0.05）. Conclusions：ETV and ETV＋Thyα-a can rapidly reduce the values of APRI and in serum of patients in the compensation period of hepatitis B accompanied by cirrhosis within 26 weeks. Persistent antiviral therapy with ETV or ETV ＋Thyα-a can maintain APRI and the value of LSM at a lower level. ETV ＋Thyα-a can mantian HBV-DNA at a lower level.However, there was no significant difference between these two treatment regimens.
作者
董佳馨
张洪玲
隋洪婷
曹艳平
曲宝聚
朴红心
DONG Jiaxin ZHANG Hongling SUI Hongting CAO Yanping QU Baoju PIAO Hongxin(College of Medicine, Yanbian University, Jilin 1330002 Department of Infection, Yanbian University Hospital)
出处
《交通医学》
2017年第3期221-224,共4页
Medical Journal of Communications
