替诺福韦联合苦参素治疗慢性乙型肝炎疗效观察
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摘要
①目的探讨乙型肝炎e抗原(HBeAg)阳性慢性乙型肝炎患者采用替诺福韦联合苦参素治疗的临床效果。②方法选取本院肝病科86例HBeAg阳性慢性乙型肝炎患者,随机分为替诺福韦对照组(43例)和替诺福韦+苦参素观察组(43例),对照组给予替诺福韦1次/天,300mg/次;观察组同时给予苦参素胶囊,3次/天,0.2g/次,治疗48周,比较两组患者治疗前及治疗24、48周后的血清丙氨酸氨基转移酶ALT(alanine amino transferase)、天冬氨酸转氨酶AST(aspartic acid transaminase)、总胆红素TBIL (total bilirubin)水平;同时比较治疗48周后,两组患者生化学应答率、病毒学应答率、联合应答率、HBeAg血清转换率以及无应答率。③结果治疗24、48周后,两组患者的ALT、AST、TBIL水平均较治疗前显著降低,且相同治疗时间点比较,观察组较对照组下降明显,差异有统计学意义(P<0.05)。连续治疗48周后,两组患者肝功指标较治疗24周显著降低,差异有统计学意义(P<0.05)。治疗48周后,比较观察组和对照组的生化学应答率、病毒学应答率、HBeAg血清学转换率、联合应答率,两组间差异有统计学意义(P<0.05)。但观察组和对照组的无应答率组间比较差异无统计学意义(P>0.05)。④结论替诺福韦联合苦参素治疗HBeAg阳性慢性乙型肝炎疗效优于单用替诺福韦治疗。
Objective To investigate the clinical effect of tenofovir combined with oxymatrine in the treatment of HBeAg positive chronic hepatitis B patients.Methods The observation objects were 86 patients with HbeAg positive chronic hepatitis B who were treated in Department of Hepatology of our hospital from November 2017 to November 2018.The 86 patients with chronic hepatitis B were randomly divided into two groups,43 cases in each group,the control group was treated with tenofovir 1 time a day,300 mg/time;At the same time the observation group received oxymatrine capsules 0.2 g/time,3 times a day,continuous treatment for 48 weeks.The serum alanine amino transferase(ALT),aspartic acid transaminase(AST),total bilirubin(TBIL) level of the observation group and the control group before treatment and 24 weeks after treatment,48 weeks after treatment were compared.At the same time,biochemical response rate,the rate of virological response,combined response rate,HBeAg seroconversion rate,non response rate of the two groups after 48 weeks treatment were compared.Results After 24 and 48 weeks treatment,ALT,AST,TBIL levels of two groups were decreased significantly,and the ALT,AST,TBIL levels of patients in the observation group were significantly lower than those in control group,with significant difference(P<0.05).After 48 weeks of treatment,ALT,AST,TBIL levels of two groups were significantly reduced compared with those after treatment of 24 weeks, with significant difference(P<0.05).After 48 weeks of treatment,the biochemical response rate,the rate of virological response,combined response rate,HBeAg seroconversion rate of the observation group group were significantly higher than those in the control group,with significant difference(P<0.05).But the non response rate of two groups had no significant difference(P>0.05).Conclusion Tenofovir combined with oxymatrine in the treatment of HBeAg positive chronic hepatitis B patients is superior to single tenofovir treatment.
Objective To investigate the clinical effect of tenofovir combined with oxymatrine in the treatment of HBeAg positive chronic hepatitis B patients.Methods The observation objects were 86 patients with HbeAg positive chronic hepatitis B who were treated in Department of Hepatology of our hospital from November 2017 to November 2018.The 86 patients with chronic hepatitis B were randomly divided into two groups,43 cases in each group,the control group was treated with tenofovir 1 time a day,300 mg/time;At the same time the observation group received oxymatrine capsules 0.2 g/time,3 times a day,continuous treatment for 48 weeks.The serum alanine amino transferase(ALT),aspartic acid transaminase(AST),total bilirubin(TBIL) level of the observation group and the control group before treatment and 24 weeks after treatment,48 weeks after treatment were compared.At the same time,biochemical response rate,the rate of virological response,combined response rate,HBeAg seroconversion rate,non response rate of the two groups after 48 weeks treatment were compared.Results After 24 and 48 weeks treatment,ALT,AST,TBIL levels of two groups were decreased significantly,and the ALT,AST,TBIL levels of patients in the observation group were significantly lower than those in control group,with significant difference(P<0.05).After 48 weeks of treatment,ALT,AST,TBIL levels of two groups were significantly reduced compared with those after treatment of 24 weeks, with significant difference(P<0.05).After 48 weeks of treatment,the biochemical response rate,the rate of virological response,combined response rate,HBeAg seroconversion rate of the observation group group were significantly higher than those in the control group,with significant difference(P<0.05).But the non response rate of two groups had no significant difference(P>0.05).Conclusion Tenofovir combined with oxymatrine in the treatment of HBeAg positive chronic hepatitis B patients is superior to single tenofovir treatment.
引文
[1] 伍俊妍,苏晨.恩替卡韦和阿德福韦酯治疗HBeAg阳性慢性乙型肝炎疗效和安全性的Meta分析[J].中国新药与临床杂志,2015,34(6):430-436
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[7] Lu YP,Liang XJ,Xiao XM,et al.Telbivudine during the second and third trimester of pregnancy interrupts HBV intrauterine transmission:a systematic review and meta-analysis[J].Clin Lab,2014,60(4):571-586
[8] 孔媛媛,尤红,贾继东,等.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》制定方法学和核心建议点评[J].中华肝脏病杂志,2015,23(7):485-487
[9] 李忠斌,邵清,李梵,等.替诺福韦酯单独与联合恩替卡韦挽救治疗恩替卡韦治疗拉米夫定经治慢性乙型肝炎失败患者疗效比较[J].肝脏,2016,21(3):165-167,208
[10] 汪梦.替诺福韦酯与拉米夫定治疗慢性乙肝疗效与安全性比较[J].当代医学,2018,24(7):107-109
[11] Kuo MT,Tseng PL,Chou YP,et al.Role of hepatitis B surface antigen in hepatitis B virus relapse after entecavir or tenofovir prophylaxis in patients undergoing cancer chemotherapy[J].J Gastroenterol Hepatol,2018,33(10):1766-1722
[12] Hou J,Wang G,Wang F,et al.Guideline of prevention and treatment for chronic hepatitis B(2015Update)[J].J Clin Transl Hepatol,2017,5(4):297-318
[13] 邱英锋,王淑英.长期应用恩替卡韦治疗拉米夫定耐药的慢性乙型肝炎患者临床疗效及安全性分析[J].实用肝脏病杂志,2018,21(2):196-199
[14] 钱雪梅,胡洁华.阿德福韦酯联合苦参素治疗HBeAg阳性慢性乙型肝炎临床观察[J].现代中西医结合杂志,2014,23(21):2368-2370
[15] 钮自宇,亓玉琴,王贺,等.替诺福韦酯联合苦参素胶囊对高病毒载量乙肝肝硬化代偿期患者的疗效观察[J].临床消化病杂志,2018,30(1):43-46
[16] 孙彦峰.苦参素联合恩替卡韦对HBeAg阳性慢性乙型肝炎的治疗效果[J].临床医学,2016,36(8):120-121
[17] 康洪华.苦参素联合恩替卡韦治疗慢性乙型肝炎80例疗效观察[J].中医中药,2016,14(32):218-218
[18] 杨友鹏,赵晓琳.替诺福韦联合苦参素胶囊对乙型肝炎肝硬化患者炎症反应和免疫功能的影响[J].中国中西医结合消化杂志,2018,26(4):349-353
[2] 冯淑焕,唐克诚,李谦.替诺福韦酯治疗多重耐药慢性乙型肝炎的回顾性分析[J].中国药房,2015,26(23):3251-3252
[3] 蔡艳.苦参素药理作用研究进展[J].实用中医药杂志,2016,32(4):387-389
[4] 高海丽,杨道坤,梁海军,等.苦参素对乙型肝炎患者免疫及纤维化状态的治疗研究[J].中华医院感染学杂志,2016,26(5):985-987
[5] 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
[6] 叶丹,王凤玲.恩替卡韦联合苦参素治疗HBeAg阳性慢性乙肝患者的近期疗效研究[J].中国现代医生,2015,53(17):93-95
[7] Lu YP,Liang XJ,Xiao XM,et al.Telbivudine during the second and third trimester of pregnancy interrupts HBV intrauterine transmission:a systematic review and meta-analysis[J].Clin Lab,2014,60(4):571-586
[8] 孔媛媛,尤红,贾继东,等.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》制定方法学和核心建议点评[J].中华肝脏病杂志,2015,23(7):485-487
[9] 李忠斌,邵清,李梵,等.替诺福韦酯单独与联合恩替卡韦挽救治疗恩替卡韦治疗拉米夫定经治慢性乙型肝炎失败患者疗效比较[J].肝脏,2016,21(3):165-167,208
[10] 汪梦.替诺福韦酯与拉米夫定治疗慢性乙肝疗效与安全性比较[J].当代医学,2018,24(7):107-109
[11] Kuo MT,Tseng PL,Chou YP,et al.Role of hepatitis B surface antigen in hepatitis B virus relapse after entecavir or tenofovir prophylaxis in patients undergoing cancer chemotherapy[J].J Gastroenterol Hepatol,2018,33(10):1766-1722
[12] Hou J,Wang G,Wang F,et al.Guideline of prevention and treatment for chronic hepatitis B(2015Update)[J].J Clin Transl Hepatol,2017,5(4):297-318
[13] 邱英锋,王淑英.长期应用恩替卡韦治疗拉米夫定耐药的慢性乙型肝炎患者临床疗效及安全性分析[J].实用肝脏病杂志,2018,21(2):196-199
[14] 钱雪梅,胡洁华.阿德福韦酯联合苦参素治疗HBeAg阳性慢性乙型肝炎临床观察[J].现代中西医结合杂志,2014,23(21):2368-2370
[15] 钮自宇,亓玉琴,王贺,等.替诺福韦酯联合苦参素胶囊对高病毒载量乙肝肝硬化代偿期患者的疗效观察[J].临床消化病杂志,2018,30(1):43-46
[16] 孙彦峰.苦参素联合恩替卡韦对HBeAg阳性慢性乙型肝炎的治疗效果[J].临床医学,2016,36(8):120-121
[17] 康洪华.苦参素联合恩替卡韦治疗慢性乙型肝炎80例疗效观察[J].中医中药,2016,14(32):218-218
[18] 杨友鹏,赵晓琳.替诺福韦联合苦参素胶囊对乙型肝炎肝硬化患者炎症反应和免疫功能的影响[J].中国中西医结合消化杂志,2018,26(4):349-353