恩替卡韦治疗甲胎蛋白升高慢性乙型肝炎患者的临床观察

目的观察恩替卡韦抗病毒治疗对甲胎蛋白（AFP）升高的慢性乙型肝炎患者肝功能、HBV DNA载量及甲胎蛋白水平的影响。方法 65例甲胎蛋白升高的慢性乙型肝炎患者（观察组）分别于恩替卡韦抗病毒治疗前及治疗96周内每隔12周测定其血清AFP、丙氨酸氨基转移酶（ALT）、总胆红素（TBil）、HBV DNA载量,以65例健康体检者作为对照组。结果治疗前及治疗后60周观察组患者血清AFP水平与对照组相比存在显著统计学差异（P〈0.01）,治疗60周后两组血清AFP水平比较无显著统计学差异（P〉0.01）;恩替卡韦治疗前后观察组患者血清AFP与同期ALT、TBil、HBV DNA水平呈显著正相关（分别为r=0.9954,P〈0.01;r=0.9911,P〈0.01;r=0.9270,P〈0.01）。结论恩替卡韦抗病毒治疗可有效抑制病毒复制、改善肝功能、降低患者血清AFP水平。另外,恩替卡韦可能延缓甚至阻断慢性乙型肝炎进展为肝癌。

Clinical observation on patients with chronic hepatitis B of high serum alpha-fetal protein level in entecavir treatment

Objective To observe the effect of entecavir on liver function,levels of HBV DNA and AFP in patients with chronic hepatitis B（CHB）of higher alpha-fetal protein（AFP）.Methods Serum AFP,alanine aminotransferase（ALT）,the total bilirubin（TBil）and HBV DNA were detected before and every 12 weeks during entecavir treatment in 65 patients with CHB.Total of 65 health examination cases were taken as control group.Results The serum AFP level of the two groups before and after treatment were compared.There was significantly statistical difference before and during the early 60 weeks＇ entecavir treatment（P0.01）and no significantly statistical difference during the later 36 weeks＇ entecavir treatment（P0.01）.Serum AFP was positively correlated with ALT,TBil and HBV DNA levels（r = 0.9954,P0.01;r = 0.9911,P0.01;r =0.9270,P0.01）before and during antiviral treatment with entecavir.Conclusions Antiviral treatment with entecavir can effectively inhibit HBV replication and improve liver function of CHB patients and reduce serum AFP level of the patients.So entecavir treatment may suspend or even block the progress to hepatocellular carcinoma（HCC）for CHB patients.