恩替卡韦治疗慢性乙型肝炎及乙型肝炎肝硬化患者的疗效分析

摘要

目的 评价恩替卡韦(ETV)治疗慢性乙型肝炎(chronic hepatitis B,CHB)及乙型肝炎肝硬化的临床疗效.方法 将2009年10月-2012年3月我院接受ETV抗病毒治疗的CHB或乙型肝炎肝硬化患者73例分成3组,其中乙型肝炎肝硬化代偿期21例(A组),乙型肝炎肝硬化失代偿期18例(B组),CHB 34例(C组).治疗期间每12周检测患者HBV DNA和ALT水平,并采用FibroScan检测肝脏硬度,分析治疗前与治疗期间各指标的变化.分析行肝脏活体组织检查的19例的肝脏硬度值与病理诊断间的相关性.结果 ETV治疗第12、24、36、48周时,3组HBV DNA检测不到率(HBV DNA＜40 IU/ml)和水平下降的中位数以及ALT复常率、FibroScan检测值改善情况相似.未发生药物相关不良反应.病理诊断结果与FibroScan检测值比较显示总符合率为57.9％.结论 ETV用于CHB或乙型肝炎肝硬化患者的抗病毒治疗,疗效确切,安全性好.FibroScan可通过动态监测肝脏硬度值变化,判定抗病毒治疗过程中肝纤维化程度的变化.%Objective To investigate the clinical efficacy of entecavir (ETV) in treating patients with chronic hepatitis B (CHB)or HBV-related cirrhosis.Methods A total of 73 patients with CHB or HBV-related cirrhosis,who received ETV treatment in our hospital from Oct.2009 to Mar.2012,were randomized into 3 groups:21 cases of HBV-related compensated cirrhosis (group A),18cases of HBV-related decompensated cirrhosis (group B) and 34 cases of CHB (group C).The levels of HBV DNA and ALT were detected and liver stiffness was measured using FibroScan every 12 weeks during the treatment,and the changes of the indicators at baseline and during the treatment were analyzed.The correlation between the values of liver stiffness and pathological findings was analyzed in 19 patients who received liver biopsy.Results At weeks 12,24,36 and 48 of treatment,the differences in the rates of HBV DNA undetectable (＜40 IU/ml),the median variation of HBV DNA levels and the decrease in ALT normalization rates and the values of liver stiffness were not significant among the 3 groups.No adverse reactions were found.The comparison of pathological findings and the values of liver stiffness showed that the total coincidence rate was 57.9％.Conclusions ETV treatment in patients with CHB or HBV-related cirrhosis is effective and safe.FibroScan can monitor the value of liver stiffness dynamically so as to assess changes in liver fibrosis during antiviral treatment.