恩替卡韦联合水飞蓟宾葡甲胺治疗慢性乙型肝炎合并NAFLD患者疗效初步研究

目的观察恩替卡韦联合水飞蓟宾葡甲胺治疗慢性乙型肝炎合并非酒精性脂肪性肝病（NAFLD）患者的临床疗效及其对血清HBsAg、HBV DNA和血清肝纤维化指标的影响。方法2015年1月~2016年1月我院诊治的慢性乙型肝炎合并NAFLD患者80例,随机将患者分为对照组40例和观察组40例。对照组患者服用恩替卡韦,观察组患者服用恩替卡韦和水飞蓟宾葡甲胺,观察24 w。结果在治疗24 w末,观察组患者血清ALT和AST分别为（64.3±27.9）U/L和（42.0±24.5）U/L,均显著低于对照组【分别为（83.7±26.0）U/L和（57.6±26.6）U/L,P<0.05】;观察组血清Ⅲ型前胶原、Ⅳ型胶原蛋白、层粘连蛋白和透明质酸酶分别为（106.0±54.5）ng/L、（69.23±21.24）ng/L、（119.2±61.2）ng/L和（119.2±71.2）ng/L,均显著低于对照组【（147.6±76.6）ng/L、（86.74±21.30）ng/、（212.7±100.3）ng/L和（205.7±91.3）ng/L,P<0.05】;观察组与对照组患者血清HBV DNA水平分别为（2.3±0.9）Ig IU/ml和（2.7±1.0）Ig IU/ml,血清HBsAg水平分别为（4458.0±945.5）S/CO和（4744.0±1256.5）S/CO,差异均无统计学意义。结论应用恩替卡韦联合水飞蓟宾葡甲胺治疗慢性乙型肝炎合并NAFLD患者较恩替卡韦单药治疗可以更有效地改善肝酶谱及血清肝纤维化指标,但对血清HBsAg水平无明显影响。

Preliminary study of the efficacy of entecavir combined with silybin neglumine amine in treatment of patients with chronic hepatitis B and NAFLD

Objective To observe the efficacy of entecavir combined with silybin meglumine amine in treatment of patients with chronic hepatitis B （CHB） and non-alcoholic fatty liver disease （NAFLD）. Methods 80 patients with CHB and NAFLD in our hospital were enrolled between January 2015 and January 2016 in this study. Patients were randomly divided into control group and observation group with 40 cases in each group. The patients in control group was treated with entecavir alone and in observation group was given entecavir combined with silybin meglumine amine. The regimen continued in both groups,and we assessed the efficacy at the end of six month treatment. Results At the end of six month treatment,serum alanine aminotransferase and aspartate amonotransferase levels in observation group were significantly lower than those in the control group（64.3±27.9） U/L vs. （83.7±26.0） U/L,and （42.0±24.5） U/L vs. （57.6±26.6） U/L,respectively,P<0.05 for both];serum levels of PCⅢ,Ⅳ-C,LN and HA in observation group were lower than those in the control group （106.0±54.5） ng/L vs. （147.6±76.6） ng/L,（69.23±21.24） ng/L vs. （86.74±21.30） ng/L,（119.2±61.2） ng/L vs. （212.7±100.3） ng/L,and （119.2±71.2） ng/L vs. （205.7±91.3） ng/L,respectively,P<0.05 for all];there were no differences as respect to serum HBV DNA and HBsAg levels between the two groups （2.3±0.9） Ig IU /ml vs. （2.7±1.0） Ig IU /ml,and （4458.0±945.5） S/CO vs. （4744.0±1256.5） S/CO,respectively,P<0.05 for both]. Conclusion The combination of entecavir and silybin meglumine amine is effective in improving liver enzymes and serum indexs of hepatic fibrosis in patients with CHB and NAFLD,but we don’t find any benefit on serum HBsAg eradication by this regimen.