恩替卡韦治疗代偿期和失代偿期乙肝肝硬化疗效比较

摘要

Objective To observe the antiviral effect of entecavir (ETV) in the treatment of patients with liv-er cirrhosis in compensatory and decompensatory phase. Methods One hundred and eight patients of liver cirrhosis were treated with ETV, including 63 patients in compensatory phase (compensated group), 45 patients in decompensa-tory phase (decompensated group). Both groups were treated for 96 weeks. Changes in liver function at different time points, hepatitis B virus (HBV) DNA, Child-pugh scores and other indicators before and after treatment were com-pared. Results 24, 48, 96 weeks after treatment, both groups were significantly improved in albumin (ALB), cholin-esterase (ChE), alanine aminotransferase (ALT), Child-pugh score, HBV DNA, compared with before treatment (P<0.05). Before treatment and 24, 48, 96 weeks after treatment, the compensated group had significantly better values of ALB, CHE, ALT, Child-pugh score, HBV DNA than the decompensated group (P<0.05). The absolute values of dif-ferences between 96 weeks after treatment and before treatment for ALB, CHE, ALT, Child-pugh score, HBV DNA were significantly higher in the compensated group than the decompensated group (P<0.05). The ALT normalization rate was 96.83%in the compensated group, and the HBV DNA negative rate was 93.65%, which were significantly higher than those in the decompensated group (P<0.05). During the course of treatment, the rate of gastrointestinal bleeding in the compensated group was 3.17%, significantly lower than 17.78% in the decompensated group (P<0.05). Conclusion ETV is effective in the treatment of both compensated and decompensated hepatitis B cirrhosis, which can improve liver function and reduce HBV DNA viral load. However, the effects for treating compensated hep-atitis B cirrhosis are significantly better.%目的：观察恩替卡韦(ETV)治疗代偿期和失代偿期乙肝肝硬化患者的抗病毒效果。方法108例乙肝肝硬化患者均采用ETV治疗，其中代偿期患者63例(代偿期组)，失代偿期患者45例(失代偿期组)，两组均治疗96周，比较两组患者治疗前后不同时间的肝功能、HBV DNA、Child-pugh积分等指标的变化。结果治疗后第24、48、96周，两组患者的白蛋白(ALB)、胆碱酯酶(ChE)、谷丙转氨酶(ALT)、Child-pugh评分、HBV-DNA检测值均较治疗前逐渐好转且差异均具有统计学意义(P<0.05)；治疗前、治疗第24、48、96周代偿期组患者的ALB、CHE、ALT、Child-pugh评分、HBV-DNA检测值均明显优于失代偿期组，差异均具有统计学意义(P<0.05)；代偿期组治疗后第96周与治疗前的ALB、CHE、ALT、Child-pugh评分、HBV-DNA检测值差值绝对值均高于失代偿期组，差异均具有统计学意义(P<0.05)；代偿期组的ALT复常率为96.83%，HBV-DNA转阴率为93.65%，均明显高于失代偿期组，差异均具有统计学意义(P<0.05)。治疗过程中，代偿期组的上消化道出血率为3.17%，明显低于失代偿期组的17.78%，差异具有统计学意义(P<0.05)。结论 ETV在治疗代偿期和失代偿期乙肝肝硬化患者中均具有改善肝功能，降低HBV-DNA病毒载量的效果，但治疗代偿期患者的效果更佳显著。