恩替卡韦联合医用臭氧治疗慢性乙型肝炎对病毒复制及肝纤维化的影响

田玉梅; 赵静; 陈盼

doi:10.3969/j.issn.1671-038X.2018.05.05

恩替卡韦联合医用臭氧治疗慢性乙型肝炎对病毒复制及肝纤维化的影响

- 秦皇岛市第二医院感染科, 河北秦皇岛 066600
基金项目:
秦皇岛市科学技术局计划项目(No:201602A139)

详细信息

作者简介:
田玉梅,本科,主治医师,研究方向:传染病学

通讯作者: 田玉梅,shuangtiec917@126.com

中图分类号: R512.62

收稿日期: 2018-01-10

The effect ofentecavir combined with major autohaemotherapy on viral replication and hepatic fibrosis in patients with chronic hepatitis B

- Department of Infectious, the Second Hospital of Qinhuangdao, Hebei, Qinhuangdao 066600, China

More Information

Corresponding author: TIAN Yu-mei, E-mail: 田玉梅,shuangtiec917@126.com

Received Date: 10 January 2018

摘要

摘要: [目的]探讨恩替卡韦(Entecavir,ETV)联合医用臭氧自血疗法(major autohaemotherapy,MAH)治疗慢性乙型肝炎(chronic hepatitis B,CHB)对病毒复制及肝纤维化的影响。[方法]选取2016年8月~2017年8月我院收治的CHB患者136例。随机分为对照组和观察组,每组各68例。对照组给予ETV口服。在此基础上,观察组加用MAH。两组均连续治疗3个月。分别于治疗前、治疗1个月、治疗3个月,采用聚合酶链反应(PCR)检测乙型肝炎病毒核酸(hepatitis B virus,HBV-DNA)定量,比较两组治疗后HBV-DNA定量下降情况。计算HBeAg血清转阴率和HBeAg血清转换率。采用酶联免疫法(ELISA)检测血清肝纤维化指标。[结果]治疗3个月,观察组HBV-DNA定量下降值,HBeAg血清转阴率和HBeAg血清转换率均高于对照组(P<0.05)。且两组HBV-DNA定量下降值,HBeAg血清转阴率和HBeAg血清转换率均高于治疗1个月(P<0.05)。治疗1个月和3个月,观察组血清透明质酸(LN)、层粘连蛋白(HA)、Ⅲ型前胶原肽(PⅢP))和Ⅳ型胶原(Ⅳ-C)均低于同期对照组(P<0.05);治疗1个月,观察组血清LN、HA、PIIIP和Ⅳ-C均低于治疗前(P<0.05);治疗3个月,两组血清LN、HA、PⅢP和Ⅳ-C均低于治疗前和治疗1个月(P<0.05)。两组均未发生严重不良反应。[结论]ETV联合MAH治疗CHB,能更加持久有效地抑制HBV的复制,同时显著改善血清肝纤维化指标,且不良反应少。值得临床推广应用。
- 慢性乙型肝炎 /
- 恩替卡韦 /
- 医用臭氧 /
- 病毒复制 /
- 肝纤维化
Abstract: [Objective]To observe the effect of entecavir(ETV)combined with major autohaemotherapy(MAH)on viral replication and hepatic fibrosis in patients with chronic hepatitis B(HBV).[Methods]136 patients with CHB admitted to our hospital from August 2016 ~ August 2017 were selected and randomly divided into the control group (n=68) and the observation group (n=68). The control group was given ETV orally. On this basis, the observation group added MAH treatment. The two groups were treated continuously for 3 months. The hepatitis B virus (HBV-DNA) was quantified by PCR, and the quantitative decline of HBV-DNA after treatment in two groups was compared. The serum negative rate of HBeAg and the rate of HBeAg seroconversion were calculated. The serum hepatic fibrosis indexes were detected by ELISA before treatment, after 1 months and 3 months treatment respectively.[Results]After 3 months of treatment, the quantitative decline of HBV-DNA, the serum negative rate of HBeAg and the HBeAg serum conversion rate were all higher than the control group (P<0.05). And two groups of HBV-DNA quantitative decline, the HBeAg serum negative rate and the HBeAg serum conversion rate were all higher than the treatment for 1 months (P<0.05). The observation group of serum hyaluronic acid (LN), laminin (HA), type Ⅲ procollagen (PⅢP) and collagen type IV (IV-C) were all lower than the control group after 1 months and 3 months treatment (P<0.05); 1 months of treatment, the serum levels of LN and HA, PⅢP and Ⅳ-C were all lower than before treatment (P<0.05); 3 months of treatment, two groups of serum LN and HA, PⅢP and Ⅳ-C were all lower than before treatment and 1 months (P<0.05). No serious adverse reactions occurred in both two groups.[Conclusion]ETV combined with MAH treat CHB could inhibit HBV replication more effectively, while improving indicators of serum hepatic fibrosis significantly, and the adverse reaction was less, which was worth of clinical application.
- chronic hepatitis B /
- entecavir /
- major autohaemotherapy /
- viral replication /
- hepatic fibrosis

HTML全文

参考文献(18)

[1]	Ahmad A A, Falla A M, Duffell E, et al.Estimating the scale of chronic hepatitis B virus infection among migrants in EU/EEA countries[J].BMC Infect Dis, 2018, 18 (1):34.-34.
[2]	何京, 陈友鹏.母婴乙型肝炎垂直传播影响因素与孕期抗病毒治疗进展[J].中华传染病杂志, 2017, 35 (5):311-314.
[3]	吴家箴, 黄仁刚, 杨兴祥, 等.317例慢性乙型肝炎患者血清HBeAg、肝组织内HBsAg和HBcAg表达强度与临床的关系[J].重庆医学, 2017, 46 (4):468-471.
[4]	侯春艳, 杨永峰.慢性乙型肝炎抗病毒治疗新进展[J].实用肝脏病杂志, 2017, 20 (1):124-128.
[5]	张莉, 张福奎.恩替卡韦治疗慢性乙型肝炎进展[J].世界华人消化杂志, 2017, 25 (1):7-16.
[6]	康海燕, 董江龙, 杨静, 等.医用臭氧对聚乙二醇干扰素治疗慢性乙型肝炎疗效的影响[J].山东医药, 2016, 56 (9):88-90.
[7]	王贵强, 王福生, 成军, 等.慢性乙型肝炎防治指南 (2015年版)[J].中国肝脏病杂志 (电子版), 2015, 7 (3):1-18.
[8]	Lee C S, Jung Y J, Kim S S, et al.Liver volume-based prediction model stratifies risks for hepatocellular carcinoma in chronic hepatitis B patients on surveillance[J].PLoS One, 2018, 13 (1):e190261.
[9]	张占卿, 陆伟, 丁荣蓉, 等.血清HBsAg、HBcrAg和HBV DNA预测慢性乙型肝炎肝组织病理状态的性能评价[J].肝脏, 2016, 21 (10):810-818.
[10]	孙丹凤, 陆许贞, 谢新生, 等.慢性乙型肝炎及肝硬化患者乙型肝炎表面抗原及乙型肝炎病毒DNA定量检测的临床意义[J].中华危重症医学杂志 (电子版), 2017, 10 (3):172-175.
[11]	俞海英, 丁巧云, 张小玉, 等.慢性乙型肝炎抗病毒治疗HBVDNA阴转后HBeAg血清学转换的分析[J].肝脏, 2017, 22 (9):810-812.
[12]	Wong D, Littlejohn M, Yuen L, et al.HBeAg levels at week 24 predict response to 8 years of tenofovir in HBeAg-positive chronic hepatitis B patients[J].Aliment Pharmacol Ther, 2018, 47 (1):114-122.
[13]	林秀梅, 朱冬林, 陈文思.肝纤维化四项检查与天冬氨酸氨基转移酶和血小板比率联合检测在诊断慢性乙型肝炎纤维化中的意义[J].中国卫生检验杂志, 2017, 27 (8):1136-1138.
[14]	Huang R, Zhao X A, Wang J, et al.Simple noninvasive tests for the detection of advanced liver fibrosis in patients with chronic hepatitis B[J].Eur J Gastroenterol Hepatol, 2018, 30 (2):241-241.
[15]	赵龙凤, 王艳.临床一线抗病毒药物对慢性乙型肝炎治疗结局的影响[J].中华肝脏病杂志, 2017, 25 (7):485-489.
[16]	聂青和.核苷酸类似物药物治疗乙型肝炎肝硬化的临床实践[J].中国实用内科杂志, 2014, 34 (6):568-571.
[17]	恩替卡韦临床应用专家共识:2015年更新[J].临床肝胆病杂志, 2016, 32 (1):32-39.
[18]	贺旭辉, 肖月霞, 陈勐, 等.臭氧治疗慢性乙型肝炎肝纤维化的临床效果及对胃肠道的影响[J].结直肠肛门外科, 2016, 22 (S2):26-27.