恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎疗效观察

目的观察恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎患者的临床效果。方法选取2017年9月-2019年1月河北医科大学第三医院收治的耐干扰素乙型肝炎患者120例,随机分为观察组和对照组,每组60例。2组均给予IFNα-2b肌肉注射治疗,观察组在此基础上给予恩替卡韦联合拉米夫定治疗。比较2组病毒学应答率、乙型肝炎表面抗原(HBsAg)转阴率,2组治疗前及治疗4、12、24周血清纤维化指标。结果观察组病毒学应答率为100. 0%,高于对照组的6. 67%(P <0. 05);观察组HBsAg转阴率为41. 67%,高于对照组的0%(P <0. 05);治疗4周后,2组透明质酸钠(HA)、层粘连蛋白(LN)、Ⅳ型胶原(C-Ⅳ)均低于治疗前,且观察组低于对照组(P <0. 05);2组Ⅲ型前胶原(PC-Ⅲ)水平比较差异无统计学意义(P> 0. 05);治疗12周后,观察组HA、LN、C-Ⅳ、PC-Ⅲ指标值均低于对照组(P <0. 05)。结论恩替卡韦联合拉米夫定治疗耐干扰素乙型肝炎效果较好,可提高病毒学应答率和HBsAg转阴率,显著改善患者的肝纤维化水平,值得临床推广应用。

Clinical efficacy of entecavir combined with lamivudine in the treatment of patients with interferon-resistant hepatitis B

Objective To investigate the clinical efficacy of entecavir combined with lamivudine in the treatment of patients with interferon-resistant hepatitis B. Methods A total of 120 patients with interferon-resistant hepatitis B who were treated in our hospital from September 2017 to January 2019 were randomly divided into two groups,including the observation group(n = 60) and the control group(n = 60). Both groups were treated with intramuscular injection of IFNα-2b. Patients in the observation group were given entecavir plus lamivudine. Compare the virological response rate and HBsAg negative rate of the two groups. Serum fibrosis indicators before and at 4,12,24 weeks. Results The virological response rate of the observation group was 100. 00%,which was significantly higher than that of the control group(6. 67%). The difference was statistically significant(P < 0. 05). The HBsAg negative rate of the observation group was 41. 67%,which was significantly higher than that of the control group(0%),and the difference was statistically significant(P < 0. 05). The values of HA,LN,C-Ⅳ,PC-Ⅲ and other indicators before treatment were similar in the two groups(P > 0. 05). From the 4 th week of treatment,the C-Ⅳ of the observation group The value was significantly lower than that of the control group. The difference was statistically significant(P < 0. 05). From the 12 th week of treatment,the HA,LN and PC-Ⅲ values of the observation group were significantly lower than the control group. The difference was statistically significant(P < 0. 05). Conclusion Entecavir combined with lamivudine in the treatment of interferon-resistant hepatitis B can significantly improve the virological response rate and HBsAg negative rate,and significantly improve the liver fibrosis level of patients,which can be used as interferon-resistant The effective program of hepatitis B patients is promoted and applied.