替比夫定对HBV感染致肝硬化代偿期患者外周血小板计数和病毒血清标志物的影响
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摘要
目的探索替比夫定对乙型肝炎病毒(HBV)感染致肝硬化代偿期患者外周血小板计数和病毒血清标志物的影响。方法选取2015年4月-2017年5月于医院接受治疗的92例HBV感染致肝硬化代偿期患者为研究对象,按照随机数字表法将患者分为对照组与试验组,每组46例,对照组患者采用常规方法治疗,试验组患者在常规治疗的基础上给予替比夫定进行治疗。检测两组患者血常规项目,包括白细胞计数(WBC)、血小板计数(PLT)、血红蛋白(HB)和白蛋白(A)等,同时检测两组患者病毒血清标志物项目,包括HBsAg滴度log值、乙型肝炎核心抗体IgM(HBcAb-IgM)和乙型肝炎核心抗体(HBcAb)等;对两组患者治疗期间的不良反应如恶心、腹泻、肌酸激酶升高(CK)、头痛等进行统计,并计算总不良反应发生率。结果试验组患者PLT为(191.64±24.56)×10~9/L,高于对照组患者(163.52±41.43)×10~9/L(P<0.05);试验组患者HBsAg滴度log值为(4.15±0.82)IU/mL、HBcAb-IgM滴度为(0.18±0.06)S/CO,高于对照组患者,试验组患者HBcAb滴度为(9.31±2.26)S/CO,低于对照组患者(P<0.05);试验组患者不良反应发生率为8.70%,低于对照组患者19.57%(P=0.024)。结论替比夫定可以降低HBV感染致肝硬化代偿期患者外周血小板计数,对病毒血清标志物影响较大,替比夫定治疗可以降低患者治疗期间的不良反应发生率,适合临床推广。
OBJECTIVE To explore the effect of telbivudine on peripheral platelet count and serum virus markers in patients at the compensatory stage of cirrhosis induced by HBV infection.METHODS A total of 92 hepatitis B patients treated in our hospital from April 2015 to May 2017 for decompensated cirrhosis caused by HBV infection were selected as the research subjects,and divided into control group and observation group according to the random number table,46 cases each group.Patients in the control group were treated by conventional methods,whereas those in the observation group were treated with telbivudine in addition to conventional therapy.Both groups of patients were examined for blood routine,including white blood cell count(WBC),platelet count(PLT),hemoglobin(HB)and albumin(A).Meanwhile,virus serum markers,including log value of HBsAg titer,hepatitis B core antibody IgM(HBcAb-IgM)and hepatitis B core antibody(HBcAb)were also examined for both groups of patients.Adverse reactions occurred during treatment of the two groups of patients,such as nausea,diarrhea,increase of creatine kinase(CK),and headache,were statistically analyzed,and the total incidence of adverse reactions was calculated.RESULTS The PLT in the observation group was(191.64±24.56)×10~9/L,which was significantly higher than that of the control group(163.52±41.43)×10~9/L(P<0.05).The log value of HBsAg titer for patients in the observation group was(4.15±0.82)IU/mL,and the HBcAb-IgM titer was(0.18±0.06)S/CO,both were significantly higher than the control group.The HBcAb titer in the observation group was(9.31±2.26)S/CO,significantly lower than the control group(P<0.05).The incidence of adverse reactions in the observation group was 8.70%,which was significantly lower than that of the control group(19.57%)(P<0.05).CONCLUSIONTelbivudine can significantly reduce the platelet count in peripheral blood of patients with decompensated cirrhosis induced by hepatitis B virus infection,and influence the virus serum markers.The telbivudine therapy can significantly reduce the incidence of adverse reactions in patients during the treatment,which is suitable for clinical application.
OBJECTIVE To explore the effect of telbivudine on peripheral platelet count and serum virus markers in patients at the compensatory stage of cirrhosis induced by HBV infection.METHODS A total of 92 hepatitis B patients treated in our hospital from April 2015 to May 2017 for decompensated cirrhosis caused by HBV infection were selected as the research subjects,and divided into control group and observation group according to the random number table,46 cases each group.Patients in the control group were treated by conventional methods,whereas those in the observation group were treated with telbivudine in addition to conventional therapy.Both groups of patients were examined for blood routine,including white blood cell count(WBC),platelet count(PLT),hemoglobin(HB)and albumin(A).Meanwhile,virus serum markers,including log value of HBsAg titer,hepatitis B core antibody IgM(HBcAb-IgM)and hepatitis B core antibody(HBcAb)were also examined for both groups of patients.Adverse reactions occurred during treatment of the two groups of patients,such as nausea,diarrhea,increase of creatine kinase(CK),and headache,were statistically analyzed,and the total incidence of adverse reactions was calculated.RESULTS The PLT in the observation group was(191.64±24.56)×10~9/L,which was significantly higher than that of the control group(163.52±41.43)×10~9/L(P<0.05).The log value of HBsAg titer for patients in the observation group was(4.15±0.82)IU/mL,and the HBcAb-IgM titer was(0.18±0.06)S/CO,both were significantly higher than the control group.The HBcAb titer in the observation group was(9.31±2.26)S/CO,significantly lower than the control group(P<0.05).The incidence of adverse reactions in the observation group was 8.70%,which was significantly lower than that of the control group(19.57%)(P<0.05).CONCLUSIONTelbivudine can significantly reduce the platelet count in peripheral blood of patients with decompensated cirrhosis induced by hepatitis B virus infection,and influence the virus serum markers.The telbivudine therapy can significantly reduce the incidence of adverse reactions in patients during the treatment,which is suitable for clinical application.
引文
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[11]黄传钟,李洁羽,陈淑萍,等.IL-2、IL-4、IL-6、IFN-γ、IL-17A在肝癌组织中表达及其与乙肝病毒感染的关系[J].中国免疫学杂志,2015,23(4):527-530.
[12]Stornaiuolo G,Cuniato V,Cuomo G,et al.Active recruitment strategy in disadvantaged immigrant populations improves the identification of human immunodeficiency but not of hepatitis B or C virus infections[J].Dig Liver Dis,2014,46(1):62-66.
[13]Heuft MM,Houba SM,van den Berk GE,et al.Protective effect of hepatitis B virus-active antiretroviral therapy against primary hepatitis B virus infection[J].AIDS,2014,28(7):999-1005.
[2]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2011,19(1):13-24.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]Luzyanina T,Bocharov G.Stochastic modeling of the impact of random forcing on persistent hepatitis B virus infection[J].Mathem Comp Simul,2014(96):54-65.
[5]Murray JM,Wieland SF,Purcell RH,et al.Dynamics of hepatitis B virus clearance in chimpanzees[J].Proc Natl Acad Sci U S A,2005,102(49):17780-17785.
[6]Liu CJ.Treatment of patients with dual hepatitis C virus and hepatitis B virus infection:resolved and unresolved issues[J].J Gastroenterol Hepatol,2014,29(1):26-30.
[7]Jutavijittum P,Andernach IE,Yousukh A,et al.Occult hepatitis B infections among blood donors in Lao PDR[J].Vox Sang,2014,106(1):31-37.
[8]Han Q,Li N,Zhu Q,et al.Association of serum soluble human leukocyte antigen-G levels with chronic hepatitis B virus infection[J].Clin Exp Med,2014,14(1):35-43.
[9]Chuai X,Wang W,Chen H,et al.Lentiviral backbone-based hepatitis B virus replicon-mediated transfer favours the establishment of persistent hepatitis B virus infection in mice after hydrodynamic injection[J].Antiviral Res,2014(101):68-74.
[10]吴艳英,卢雪红,于宏宇,等.激素联合他克莫司和咪唑立宾治疗伴乙肝病毒感染的狼疮性肾炎10例[J].中国老年学杂志,2014,31(20):5867-5869.
[11]黄传钟,李洁羽,陈淑萍,等.IL-2、IL-4、IL-6、IFN-γ、IL-17A在肝癌组织中表达及其与乙肝病毒感染的关系[J].中国免疫学杂志,2015,23(4):527-530.
[12]Stornaiuolo G,Cuniato V,Cuomo G,et al.Active recruitment strategy in disadvantaged immigrant populations improves the identification of human immunodeficiency but not of hepatitis B or C virus infections[J].Dig Liver Dis,2014,46(1):62-66.
[13]Heuft MM,Houba SM,van den Berk GE,et al.Protective effect of hepatitis B virus-active antiretroviral therapy against primary hepatitis B virus infection[J].AIDS,2014,28(7):999-1005.