慢性乙型肝炎患者抗病毒治疗后肝纤维化动态变化的定性评估
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摘要
目的定性评估慢性乙型肝炎患者抗病毒治疗后肝纤维化的动态变化。方法选取2017年1月至2017年12月于松岗人民医院接受治疗的慢性乙型肝炎患者112例为研究对象,采用随机数字表法分为观察组和对照组,每组56例。观察组患者采用安络化纤丸联合α-干扰素治疗,对照组患者仅采用α-干扰素治疗,观察两组患者临床症状(肝区痛、腹胀及肝肿大)、肝纤维化指标[(透明质酸酶(hyaluronidase,HA)、层粘连蛋白(laminin,LN)及C3氨基端肽(C3 amino terminal peptide,P3P)]及肝功能指标(ALT、TBil和γ球蛋白)的差异。结果治疗后,观察组患者肝区痛、腹胀及肝肿大的改善均显著优于对照组,血清肝纤维化指标(HA、LN和P3P)和肝功能指标(ALT、TBil和γ球蛋白)均显著低于对照组,差异有统计学意义(P <0.05)。治疗后,观察组患者的HBeAg阴转率、HBeAg血清学转换率和HBV DNA低于检测下限率分别为50.0%、45.6%和60.9%,对照组分别为26.0%、21.6%和37.9%,差异有统计学意义(χ~2值分别为6.380、6.821、6.038,P值分别为0.012、0.009、0.014)。结论慢性乙型肝炎患者采用安络化纤丸联合α-干扰素治疗,可显著降低血清肝纤维化指标,改善患者肝功能及临床指征,值得临床推广。
Objective To evaluate the dynamic changes of liver fibrosis in patients with chronic hepatitis B after antiviral therapy qualitatively. Methods Total of 112 cases with chronic hepatitis B in People's Hospital of Songgang from January 2017 to December 2017 were selected and divided into observation group and control group according to random digital table method, 56 cases in each group. Patients in observation group were treated with Anluo Hua Xian pill combined with alpha interferon, patients in control group were treated with alpha interferon only. The clinical symptoms(liver pain, abdominal distention and hepatomegaly), hepatic fibrosis indexes [hyaluronidase(HA), laminin(LN), C3 amino terminal peptide(P3 P)] and liver function indexes(ALT, TBil and γ-globulin) were observed. Results After treatment, the improvement of liver pain, abdominal distension and hepatomegaly of patients in observation group were significantly better than those in control group, and the indexes of liver fibrosis(HA, LN and P3 P) and liver function(ALT, TBil and γ globulin) were significantly lower than those in control group. The differences were statistically significant(P < 0.05). After treatment, the negative conversion rate of HBeAg, the conversion rate of HBeAg and the rate of HBV DNA below the detection limit were 50.0%, 45.6% and 60.9% in observation group, and 26.0%, 21.6% and 37.9% in control group, respectively, the differences were statistically significant(χ~2=6.380, 6.821, 6.038; P = 0.012, 0.009, 0.014). Conclusions Anluo Hua Xian pill combined with alpha interferon can significantly reduce the serum hepatic fibrosis indexes, improve the liver function and clinical indications of patients with chronic hepatitis B, which is worthy of popularizing in clinical practice.
Objective To evaluate the dynamic changes of liver fibrosis in patients with chronic hepatitis B after antiviral therapy qualitatively. Methods Total of 112 cases with chronic hepatitis B in People's Hospital of Songgang from January 2017 to December 2017 were selected and divided into observation group and control group according to random digital table method, 56 cases in each group. Patients in observation group were treated with Anluo Hua Xian pill combined with alpha interferon, patients in control group were treated with alpha interferon only. The clinical symptoms(liver pain, abdominal distention and hepatomegaly), hepatic fibrosis indexes [hyaluronidase(HA), laminin(LN), C3 amino terminal peptide(P3 P)] and liver function indexes(ALT, TBil and γ-globulin) were observed. Results After treatment, the improvement of liver pain, abdominal distension and hepatomegaly of patients in observation group were significantly better than those in control group, and the indexes of liver fibrosis(HA, LN and P3 P) and liver function(ALT, TBil and γ globulin) were significantly lower than those in control group. The differences were statistically significant(P < 0.05). After treatment, the negative conversion rate of HBeAg, the conversion rate of HBeAg and the rate of HBV DNA below the detection limit were 50.0%, 45.6% and 60.9% in observation group, and 26.0%, 21.6% and 37.9% in control group, respectively, the differences were statistically significant(χ~2=6.380, 6.821, 6.038; P = 0.012, 0.009, 0.014). Conclusions Anluo Hua Xian pill combined with alpha interferon can significantly reduce the serum hepatic fibrosis indexes, improve the liver function and clinical indications of patients with chronic hepatitis B, which is worthy of popularizing in clinical practice.
引文
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[10]丁茜,李振,刘滨,等.卡维地洛抑制血小板衍生因子BB诱导的人肝星状细胞活化和纤维化的作用机制[J].临床肝胆病杂志,2017,33(3):485-491.
[11]唐情容,何清,唐奇远,等.慢性乙型肝炎肝纤维化无创性诊断模型的研究进展[J].临床肝胆病杂志,2015,31(8):1355-1359.
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[13]Tsai TY,Hung TH,Livneh H,et al.Chinese herbal medicine therapy and the risk of mortality for chronic hepatitis B patients with concurrent liver cirrhosis:a nationwide population-based cohort study[J].Oncotarget,2018,9(26):18214-18223.
[14]Friedman A,Siewe N.Chronic hepatitis B virus and liver fibrosis:Amathematical model[J].PLoS One,2018,13(4):e0195037.
[15]Calès P,Boursier J,Oberti F,et al.A single blood test adjusted for different liver fibrosis targets improves fibrosis staging and especially cirrhosis diagnosis[J].Hepatol Commun,2018,2(4):455-466.
[16]房荣,马小勇.肝爽颗粒联合恩替卡韦抗病毒治疗乙肝肝硬化的临床效果[J].临床医学研究与实践,2018,3(3):117-118.
[17]柴霞.护理干预对乙肝肝硬化患者院外遵医行为及再入院率的影响[J].基层医学论坛,2018,22(3):346-347.
[18]崔秀珍.恩替卡韦与复方鳖甲软肝片联合治疗乙肝后肝硬化患者的临床效果[J].临床医药文献杂志,2018,5(5):166-167.
[19]俞冲,李民,顾玉玲,等.APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值[J].肝脏,2018,23(1):22-25.
[20]赵云,朱培福.恩替卡韦联合微生态制剂对乙肝肝硬化患者肝功能、HBV-DNA和肝纤维化指标的影响[J].河北医药,2018,40(5):759-761.
[21]王海娟,黎莹莹,邓鑫,等.中西医结合治疗乙肝肝硬化腹水研究概况[J].实用中医药杂志,2018,34(2):269-270.
[22]许丰.乙酰谷酰胺联合纳洛酮治疗乙肝肝硬化肝性脑病的疗效及对NH3、IL-6的影响[J].现代医院,2018,18(2):271-273.
[23]王春娥.熊去氧胆酸治疗慢性乙肝及肝硬化伴胆汁淤积的疗效观察[J].中国实用医药,2018,13(9):130-131.
[24]刘祖明,邹灿.乙肝肝硬化患者FibroScan参数与血清炎症指标、胶原代谢指标及纤维化指标的相关性[J].海南医学院学报,2018,24(5):597-600.
[25]吕建林,柳琳琳,黄瑞,等.复方鳖甲软肝片联合恩替卡韦治疗乙肝肝硬化的疗效及安全性观察[J].中成药,2018,40(4):1000-1005.
[2]张扬武,罗伟生,黄瑞,等.六味五灵片联合核苷(酸)类抗病毒药对慢性乙型肝炎肝纤维化的Meta分析[J].中华中医药学刊,2017,35(3):589-595.
[3]梁携儿,陈永鹏.肝纤维化评估在慢性乙型肝炎抗病毒治疗决策和疗效监测中的作用[J].临床肝胆病杂志,2016,32(11):2058-2061.
[4]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华内科杂志,2001,40(1):62-68.
[5]李玉宇,郜玉峰,马双双,等.恩替卡韦治疗谷丙转氨酶低于2倍正常值上限的慢性乙型肝炎患者的疗效观察[J].安徽医药,2016,20(6):1189-1191.
[6]张伟娜,吴小红.瞬时肝弹性测定早期干预慢性乙型肝炎60例临床观察[J].中国现代药物应用,2016,10(10):158-159.
[7]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/CD].中国肝脏病杂志(电子版),2015,7(3):1-18.
[8]占国清,李芳,李儒贵,等.非酒精性脂肪性肝病对慢性乙型肝炎肝纤维化及α-干扰素抗病毒疗效的影响[J].胃肠病学和肝病学杂志,2016,25(4):394-397.
[9]严丽波,唐红.慢性乙型肝炎诊治进展和展望[J].实用医院临床杂志,2016,13(2):5-9.
[10]丁茜,李振,刘滨,等.卡维地洛抑制血小板衍生因子BB诱导的人肝星状细胞活化和纤维化的作用机制[J].临床肝胆病杂志,2017,33(3):485-491.
[11]唐情容,何清,唐奇远,等.慢性乙型肝炎肝纤维化无创性诊断模型的研究进展[J].临床肝胆病杂志,2015,31(8):1355-1359.
[12]胡晓云,刘智泓,孙剑.《2015年世界卫生组织慢性乙型肝炎病毒感染预防、关怀和治疗指南》解读:无创肝纤维化评估、抗病毒治疗策略和国家防治计划实施[J].临床肝胆病杂志,2015,31(6):829-832.
[13]Tsai TY,Hung TH,Livneh H,et al.Chinese herbal medicine therapy and the risk of mortality for chronic hepatitis B patients with concurrent liver cirrhosis:a nationwide population-based cohort study[J].Oncotarget,2018,9(26):18214-18223.
[14]Friedman A,Siewe N.Chronic hepatitis B virus and liver fibrosis:Amathematical model[J].PLoS One,2018,13(4):e0195037.
[15]Calès P,Boursier J,Oberti F,et al.A single blood test adjusted for different liver fibrosis targets improves fibrosis staging and especially cirrhosis diagnosis[J].Hepatol Commun,2018,2(4):455-466.
[16]房荣,马小勇.肝爽颗粒联合恩替卡韦抗病毒治疗乙肝肝硬化的临床效果[J].临床医学研究与实践,2018,3(3):117-118.
[17]柴霞.护理干预对乙肝肝硬化患者院外遵医行为及再入院率的影响[J].基层医学论坛,2018,22(3):346-347.
[18]崔秀珍.恩替卡韦与复方鳖甲软肝片联合治疗乙肝后肝硬化患者的临床效果[J].临床医药文献杂志,2018,5(5):166-167.
[19]俞冲,李民,顾玉玲,等.APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值[J].肝脏,2018,23(1):22-25.
[20]赵云,朱培福.恩替卡韦联合微生态制剂对乙肝肝硬化患者肝功能、HBV-DNA和肝纤维化指标的影响[J].河北医药,2018,40(5):759-761.
[21]王海娟,黎莹莹,邓鑫,等.中西医结合治疗乙肝肝硬化腹水研究概况[J].实用中医药杂志,2018,34(2):269-270.
[22]许丰.乙酰谷酰胺联合纳洛酮治疗乙肝肝硬化肝性脑病的疗效及对NH3、IL-6的影响[J].现代医院,2018,18(2):271-273.
[23]王春娥.熊去氧胆酸治疗慢性乙肝及肝硬化伴胆汁淤积的疗效观察[J].中国实用医药,2018,13(9):130-131.
[24]刘祖明,邹灿.乙肝肝硬化患者FibroScan参数与血清炎症指标、胶原代谢指标及纤维化指标的相关性[J].海南医学院学报,2018,24(5):597-600.
[25]吕建林,柳琳琳,黄瑞,等.复方鳖甲软肝片联合恩替卡韦治疗乙肝肝硬化的疗效及安全性观察[J].中成药,2018,40(4):1000-1005.