核苷类药物对34例慢性重型乙型肝炎的抗肝纤维化效果分析

目的探讨抗病毒治疗对慢性重型乙型肝炎的抗纤维化疗效。方法收集慢性重型乙型肝炎病例，选取34例为治疗组，历史病例30例为对照组。治疗组在常规内科治疗的基础上加用抗病毒药物治疗（拉米夫定、恩替卡韦、替比夫定），对照组仅使用内科常规治疗。分析两组患者在不同时间点血清学肝纤维化指标检测及肝穿刺组织学活检结果。结果治疗组治疗前与治疗后3个月比较，层黏蛋白（LN）、Ⅲ型前胶原（PCⅢ）、透明质酸（HA）和Ⅳ胶原（IVC）差异均无统计学意义（P〉0．05）。治疗后18个月，LN、PCIU、HA和IVC均明显下降，与治疗前比较，差异有统计学意义（P〈0．05）。与治疗后3个月相比，治疗组18个月后52．9％（18／34）的患者肝组织学改善（治疗后HAI积分下降〉2），其中47．0％（16／34）的患者坏死炎性反应程度改善（治疗后积分下降〉2），35．3％（12／34）的患者纤维化程度改善（治疗后积分下降〉1），差异均有统计学意义（P〈0．05）。对照组患者治疗前后肝纤维化指标检测及肝穿刺组织学活检结果差异无统计学意义。结论抗病毒治疗能抑制慢性重型乙型肝炎患者的肝纤维化，使肝组织炎症明显好转，减少肝炎后肝硬化的发生率。

Anti-fibrosis effects of nucleoside analogues on 34 chronic severe hepatitis B patients

Objective To explore the anti-fibrosis efficacy of antiviral treatment in patients with chronic severe hepatitis B. Methods Patients with chronic severe hepatitis B were selected in this study. Antiviral treatment group （34 cases ） was treated with antiviral therapy （LAM or ETV or Ltd） and routine supportive therapy, and the control group （30 historical cases） was treated with supportive therapy only. The liver fibrosis markers in serum and liver biopsy were analyzed. Results After 3 months of treatment, there was no significant difference in the levels of LN, PC HI , HA and IV C （P〉0.05） in the antiviral treatment group. After 18 months of treatment, the levels of LN, PC m, HA and IV C were decreased obviously, and the difference was statistically significant （P〈0.05）.Compared with the 3-month treatment group, 52.9% （18/34） of patients had an improvement in their liver histology （reduction of HAI score 2）after 18 months of antiviral treatment with nucleoside drugs. Furthermore ,47.0% （16/34） of the patients had a significant reduction of necrosis and their total hepatic HAI score （2） ,and 35.3%（12/34） of the patients had an improvement of fibrosis （P〈 0.05）.There was no significant difference in the liver fibrosis markers in serum and the results of liver biopsybetween the control and treatment group. Conclusion Antiviral treatment can inhibitliver fibrosis in patients with chronic severe hepatitis B. It can also improve the inflammation in liver tissue and decrease the rate of liver cirrhosis.