恩替卡韦治疗乙型肝炎肝硬化与慢性乙型肝炎96周的疗效

目的观察比较恩替卡韦治疗乙型肝炎肝硬化与慢性乙型肝炎患者96周的疗效。方法收集初治的乙型肝炎肝硬化患者71例(肝硬化组),慢性乙型肝炎患者89例(乙型肝炎组),均给予恩替卡韦0.5mg,每日1次,口服治疗,持续抗病毒治疗96周,观察两组患者在治疗前、治疗第12、24、48、96周时病毒学、血清学、生物化学指标、出凝血时间、Child-Pugh积分及肾功能等变化情况。结果①恩替卡韦治疗后,两组患者乙型肝炎病毒核糖核酸(HBV DNA)、丙氨酸转氨酶(ALT)水平均较治疗前明显下降,发生乙型肝炎e抗原(HBeAg)阴转及血清学转换的例数逐渐增加,但两组各时间点比较,差异均无统计学意义。②肝储备功能方面,恩替卡韦治疗后,两组患者白蛋白、总胆红素、凝血酶原时间均有不同程度改善,随着治疗的延长,白蛋白不断升高,总胆红素持续下降,凝血酶原时间减小,两组患者治疗48及96周白蛋白、总胆红素、凝血酶原时间及Child-Pugh积分与基线值比较,差异均有统计学意义(P0.05或0.01)。组间比较显示,白蛋白升高水平、总胆红素及凝血酶原时间下降水平在肝硬化失代偿组最高,肝硬化代偿组次之,慢性乙型肝炎组最低,差异均具有统计学意义。③两组患者治疗过程中,均未出现血清肌酐增高超过正常参考值范围情况。结论应用恩替卡韦抗病毒治疗,乙型肝炎肝硬化患者的病毒学、血清学及生化学应答均与慢性乙型肝炎患者相似,同时抗病毒治疗能明显改善各阶段乙型肝炎患者肝储备功能,其中乙型肝炎肝硬化失代偿期患者最为显著。

Efficacy of entecavir for 96 weeks in patients with hepatitis B virus-related cirrhosis and chronic hepatitis B

Objective To compare the antiviral efficacy of entecavir for 96 weeks in patients with hepatitis B virus-related cirrhosis and chronic hepatitis B.Methods A total of 160 cases were collected,including 71 patients with hepatitis B virus-related cirrhosis and 89 patients with chronic hepatitis B,who had not previously received a nucleoside analogue,all the patients received 0.5 mg of entecavir once daily for 96 weeks.Virological,serological,biochemical markers,prothrombin time,Child-Pugh scores and renal function were observed at different time during the course of therapy.Results ①The levels of HBV DNA and ALT decreased obviously,and the number of patients with HBeAg seroconversion increased gradually after ETV therapy in both groups,however there were no significant difference between two groups at different time.② With the treatment prolonged,the serum albumin,total bilirubin,and prothrombin time were improved to some extent in both groups.The serum albumin,total bilirubin,prothrombin time and Child-Pugh score were markedly higher at week 48 and 96 compared with their baseline statistically.By group analysis,the increased margins of serum albumin,the decreased margins of total bilirubin,prothrombin time,Child-Pugh score from the baseline were the highest in the decompensated cirrhosis group and higher in the compensated cirrhosis group than the chronic hepatitis group.③There was no evidence of serum creatinine increasing above the upper limit of normal during treatment in two groups.Conclusion The antiviral efficacy in patients with hepatitis B liver cirrhosis and chronic hepatitis B on virology,serology and biochemical responses are similar by entecavir. Meanwhile,antiviral treatment can improve hepatic reserve at all stages and was most beneficial and significant for decompensated cirrhosis.