前列地尔联合核苷类抗病毒药物对HBV感染失代偿期肝硬化患者肝功能、肝纤维化指标及血清炎性因子的影响
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摘要
目的:探讨前列地尔联合核苷类抗病毒药物对HBV感染失代偿期肝硬化患者肝功能、肝纤维化指标及血清炎性因子的影响。方法:选取HBV感染失代偿期肝硬化患者136例,随机分为对照组和病例组各68例。对照组给予常规护肝和抗病毒治疗;病例组在对照组治疗的基础上加用前列地尔治疗。观察两组治疗前后肝功能、肝纤维化、肝脾影像学指标、抗病毒相关指标以及炎症因子的变化。结果:病例组的总有效率显著高于对照组,差异有统计学意义(P<0.05);病例组治疗后的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、层黏连蛋白(LN)、Ⅳ型胶原(CIV)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、门静脉内径、脾静脉内径、脾脏厚度、血清白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、转化生长因子β1(TGF-β1)显著低于对照组,白蛋白(ALB)、HBV DNA转阴率、HBsAg转阴率、HBeAg转阴率显著高于对照组,差异有统计学意义(P<0.05)。结论:前列地尔联合核苷类抗病毒药物可以明显改善HBV感染失代偿期肝硬化患者的肝功能,减轻肝纤维化程度、抑制血清炎性因子产生,并能有效抑制HBV复制,临床疗效显著,具有一定的临床推广应用价值。
Objective: To explore the Effects of alprostadil combined with nucleoside antiviral drugs on liver function, liver fibrosis markers and serum inflammatory factors in patients with decompensated liver cirrhosis with HBV infection. Methods: 136 patients with decompensated cirrhosis of HBV infection who were hospitalized in Linxi Hospital of Kailuan General Hospital, Tangshan Infectious Disease Hospital and North China University of Technology Hospital from January to February 2018, 2017 were selected. All patients were divided into control group and case group by random number table method, 68 cases in each group. The control group was treated with routine liver protection and antiviral therapy, while the case group was treated with alprostadil on the basis of the control group. The changes of liver function, liver fibrosis, liver and spleen imaging indexes, anti-virus-related indexes and inflammatory factors were observed before and after treatment in the two groups. Results: The total effective rate of the case group was 97.06%, which was significantly higher than that of the control group(85.29%), and the difference was statistically significant(P<0.05). The ALT, AST, TBIL, LN, HA, PCIII, CIV, portal vein diameter, spleen vein diameter, spleen thickness, IL-6, hs-CRP, TNF-α and TGF-β1 were significantly lower in the case group than in the control group. ALB, HBV DNA conversion rate, HBsAg negative rate, and HBeAg negative rate were significantly higher than the control group, the difference was statistically significant(P<0.05). Conclusion: Alprostadil combined with nucleoside antiviral drugs can significantly improve the decompensation of HBV infection Liver function in patients with cirrhosis, reduce the degree of liver fibrosis, inhibit the production of serum inflammatory factors, and can effectively inhibit HBV replication, clinical efficacy is significant, with certain clinical application value.
Objective: To explore the Effects of alprostadil combined with nucleoside antiviral drugs on liver function, liver fibrosis markers and serum inflammatory factors in patients with decompensated liver cirrhosis with HBV infection. Methods: 136 patients with decompensated cirrhosis of HBV infection who were hospitalized in Linxi Hospital of Kailuan General Hospital, Tangshan Infectious Disease Hospital and North China University of Technology Hospital from January to February 2018, 2017 were selected. All patients were divided into control group and case group by random number table method, 68 cases in each group. The control group was treated with routine liver protection and antiviral therapy, while the case group was treated with alprostadil on the basis of the control group. The changes of liver function, liver fibrosis, liver and spleen imaging indexes, anti-virus-related indexes and inflammatory factors were observed before and after treatment in the two groups. Results: The total effective rate of the case group was 97.06%, which was significantly higher than that of the control group(85.29%), and the difference was statistically significant(P<0.05). The ALT, AST, TBIL, LN, HA, PCIII, CIV, portal vein diameter, spleen vein diameter, spleen thickness, IL-6, hs-CRP, TNF-α and TGF-β1 were significantly lower in the case group than in the control group. ALB, HBV DNA conversion rate, HBsAg negative rate, and HBeAg negative rate were significantly higher than the control group, the difference was statistically significant(P<0.05). Conclusion: Alprostadil combined with nucleoside antiviral drugs can significantly improve the decompensation of HBV infection Liver function in patients with cirrhosis, reduce the degree of liver fibrosis, inhibit the production of serum inflammatory factors, and can effectively inhibit HBV replication, clinical efficacy is significant, with certain clinical application value.
引文
1 刘斌,张国顺,杨美荣,等.肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J].世界华人消化杂志,2016,24(18):2892-2897.
2 杨年欢,袁国盛,周宇辰,等.恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化96周的临床疗效[J].南方医科大学学报,2016,36(6):775-779.
3 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(2015年版)[J].泸州医学院学报,2016,39(1):1-20.
4 葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2014:419-423.
5 何峰,王慧,刘超.恩替卡韦对乙肝肝硬化代偿期乙肝病毒应答、肝功能水平的影响[J].海南医学,2016,27(13):2121-2123.
6 娄海泉.替比夫定、阿德福韦酯联用与恩替卡韦单药治疗失代偿期乙肝肝硬化疗效对比研究[J].包头医学,2017,41(4):2-4.
7 贺露露,陈飞.阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化患者血清细胞因子水平的变化[J].实用肝脏病杂志,2017,20(2):234-235.
8 龚诗,苏海飞,苏雪梅,等.复方丹参片联合核苷类抗病毒药物对乙型肝炎肝硬化患者纤维化指标及网织红细胞参数的影响研究[J].中华医院感染学杂志,2016,26(15):3370-3372.
9 李飞鹏.恩替卡韦与阿德福韦酯治疗乙型肝炎失代偿期肝硬化的疗效及对甲状腺功能的影响[J].肝脏,2019,24(1):54-57.
10 刘宇,杜漫,王慧雯,等.替比夫定与恩替卡韦对阿德福韦酯相关肾损害的慢性乙型肝炎患者肾功能改善效果比较及其影响因素[J].广西医学,2017,39(4):440-443.
11 肖玉柱.阿德福韦酯联合恩替卡韦治疗老年失代偿期乙型肝炎相关肝硬化患者疗效及血清细胞因子水平变化[J].实用肝脏病杂志,2017,20(5):546-549.
12 程燕,颜默磊,王玲,等.恩替卡韦与阿德福韦酯对乙型病毒性肝炎失代偿性肝硬化患者甲状腺功能和肝功能的影响[J].世界华人消化杂志,2018,26(5):311-317.
13 杨军,魏敏,石菡.两种抗乙肝病毒方案治疗乙型肝炎肝硬化患者的疗效及对肾功能影响比较[J].四川医学,2017,38(10):1161-1164.
14 徐明丽.替比夫定、阿德福韦酯联用与恩替卡韦单药治疗失代偿期乙型肝炎肝硬化的效果对比观察[J].中国生化药物杂志,2017,37(11):85-86,88.
15 徐静,陶琳琳,叶娇娇,等.替比夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者疗效及其对肾功能的影响[J].实用肝脏病杂志,2019,22(1):89-92.
16 杨军,魏敏,李艳芳.两种核苷(酸)类药物治疗乙型肝炎肝硬化伴肝源性糖尿病的疗效比较[J].河北医学,2017,23(3):442-445.
17 袁剑峰,张翠芳,王佐兵,等.维生素D联合前列地尔治疗难治性原发性胆汁性肝硬化疗效观察[J].肝脏,2017,22(9):812-816.
18 袁剑峰,张翠芳.维生素D联合前列地尔对熊去氧胆酸应答不佳的原发性胆汁性肝硬化疗效观察[J].中国中西医结合消化杂志,2017,25(9):651-655.
19 宋洁,韩莹波,贾胜男,等.前列地尔干预乙型肝炎肝硬化患者纤维化指标及对IL-6、TNF-α的影响[J].肝脏,2018,23(8):702-705.
20 韦志平.前列地尔治疗老年失代偿期乙型肝炎肝硬化疗效及对血清炎性因子水平的影响[J].中国药业,2018,27(14):70-72.
21 王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.
22 范文博,徐跃迪,杨昭君,等.前列地尔联合替诺福韦对乙肝肝硬化伴肝源性糖尿病患者的临床疗效[J].广东医学,2018,39(19):2968-2971.
23 龙志玲,邵泽勇,伍锡刚,等.前列地尔联合复方鳖甲软肝片治疗慢性乙型肝炎肝硬化的疗效观察[J].现代药物与临床,2018,33(1):134-138.
24 刘玉玲,冯振清,贾秋龙,等.恩替卡韦联合前列地尔对乙型肝炎肝硬化腹水患者肝肾功能恢复及预后的影响[J].慢性病学杂志,2017,18(9):1038-1040.
25 王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.
2 杨年欢,袁国盛,周宇辰,等.恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化96周的临床疗效[J].南方医科大学学报,2016,36(6):775-779.
3 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(2015年版)[J].泸州医学院学报,2016,39(1):1-20.
4 葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2014:419-423.
5 何峰,王慧,刘超.恩替卡韦对乙肝肝硬化代偿期乙肝病毒应答、肝功能水平的影响[J].海南医学,2016,27(13):2121-2123.
6 娄海泉.替比夫定、阿德福韦酯联用与恩替卡韦单药治疗失代偿期乙肝肝硬化疗效对比研究[J].包头医学,2017,41(4):2-4.
7 贺露露,陈飞.阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化患者血清细胞因子水平的变化[J].实用肝脏病杂志,2017,20(2):234-235.
8 龚诗,苏海飞,苏雪梅,等.复方丹参片联合核苷类抗病毒药物对乙型肝炎肝硬化患者纤维化指标及网织红细胞参数的影响研究[J].中华医院感染学杂志,2016,26(15):3370-3372.
9 李飞鹏.恩替卡韦与阿德福韦酯治疗乙型肝炎失代偿期肝硬化的疗效及对甲状腺功能的影响[J].肝脏,2019,24(1):54-57.
10 刘宇,杜漫,王慧雯,等.替比夫定与恩替卡韦对阿德福韦酯相关肾损害的慢性乙型肝炎患者肾功能改善效果比较及其影响因素[J].广西医学,2017,39(4):440-443.
11 肖玉柱.阿德福韦酯联合恩替卡韦治疗老年失代偿期乙型肝炎相关肝硬化患者疗效及血清细胞因子水平变化[J].实用肝脏病杂志,2017,20(5):546-549.
12 程燕,颜默磊,王玲,等.恩替卡韦与阿德福韦酯对乙型病毒性肝炎失代偿性肝硬化患者甲状腺功能和肝功能的影响[J].世界华人消化杂志,2018,26(5):311-317.
13 杨军,魏敏,石菡.两种抗乙肝病毒方案治疗乙型肝炎肝硬化患者的疗效及对肾功能影响比较[J].四川医学,2017,38(10):1161-1164.
14 徐明丽.替比夫定、阿德福韦酯联用与恩替卡韦单药治疗失代偿期乙型肝炎肝硬化的效果对比观察[J].中国生化药物杂志,2017,37(11):85-86,88.
15 徐静,陶琳琳,叶娇娇,等.替比夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者疗效及其对肾功能的影响[J].实用肝脏病杂志,2019,22(1):89-92.
16 杨军,魏敏,李艳芳.两种核苷(酸)类药物治疗乙型肝炎肝硬化伴肝源性糖尿病的疗效比较[J].河北医学,2017,23(3):442-445.
17 袁剑峰,张翠芳,王佐兵,等.维生素D联合前列地尔治疗难治性原发性胆汁性肝硬化疗效观察[J].肝脏,2017,22(9):812-816.
18 袁剑峰,张翠芳.维生素D联合前列地尔对熊去氧胆酸应答不佳的原发性胆汁性肝硬化疗效观察[J].中国中西医结合消化杂志,2017,25(9):651-655.
19 宋洁,韩莹波,贾胜男,等.前列地尔干预乙型肝炎肝硬化患者纤维化指标及对IL-6、TNF-α的影响[J].肝脏,2018,23(8):702-705.
20 韦志平.前列地尔治疗老年失代偿期乙型肝炎肝硬化疗效及对血清炎性因子水平的影响[J].中国药业,2018,27(14):70-72.
21 王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.
22 范文博,徐跃迪,杨昭君,等.前列地尔联合替诺福韦对乙肝肝硬化伴肝源性糖尿病患者的临床疗效[J].广东医学,2018,39(19):2968-2971.
23 龙志玲,邵泽勇,伍锡刚,等.前列地尔联合复方鳖甲软肝片治疗慢性乙型肝炎肝硬化的疗效观察[J].现代药物与临床,2018,33(1):134-138.
24 刘玉玲,冯振清,贾秋龙,等.恩替卡韦联合前列地尔对乙型肝炎肝硬化腹水患者肝肾功能恢复及预后的影响[J].慢性病学杂志,2017,18(9):1038-1040.
25 王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.