应用恩替卡韦抗病毒治疗对代偿期乙肝肝硬化患者血清甲状腺激素水平及肝功能的影响

摘要

目的：探讨恩替卡韦（ETV）对代偿期乙肝肝硬化患者血清甲状腺激素（TH）水平的影响。方法：选取代偿期乙肝肝硬化患者67例为观察组，在对症支持治疗、维持电解质平衡等综合治疗的同时使用 ETV。另选取同期来院健康体检者50例为对照组，比较两组血清 TH 水平，以及治疗后观察组内乙肝病毒的脱氧核糖核酸（HBV-DNA）转阴和为转阴患者血清TH 和肝功能水平，记录用药期间不良反应。结果：治疗后，观察组 HBV-DNA 转阴49例，未转阴16例，转阴患者血清总三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离总甲状腺素（FT4）水平及肝功能指标白蛋白（ALB）水平显著高于治疗前及未转阴患者（P ＜0．05或 P ＜0．01），而血清促甲状腺激素（TSH）水平及肝功能指标天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、凝血酶原时间（PT）、总胆红素（TBIL）水平显著低于治疗前及未转阴患者（P ＜0．05或P ＜0．01）。观察组在治疗过程中未见严重不良反应。结论：ETV 可显著改善代偿期乙肝肝硬化患者肝功能状态，从而改善血清 TH 水平，且相对安全。%Objective:To investigate the effect of Entecavir (ETV)on serum levels of thyroid hormone (TH)in patients with hepatitis B virus-related compensated cirrhosis.Methods:A total of 67 patients with hepatitis B virus-related compensated cirrhosis were recruited as the observation group,and were administrated with entecavir in addition to supportive treatment and maintaining fluid and electrolyte acid-base balance.Another 50 healthy participants were included as the control group.Serum levels of TH between the observation group and the control group,and levels of serum TH and liver function indexes between patients with HBV-DNA negative conversion and without HBV-DNA negative conversion after treatment were compared.Results:There were 49 cases with HBV-DNA negative conversion and 16 cases without HBV-DNA negative conversion in the observation group after treatment.The serum levels of to-tal triiodothyronine (T3),total thyroxine (T4),free triiodothyronine (FT3),free thyroxine (FT4)and albumin (ALB)were higher in those with HBV-DNA negative conversion than those without HBV-DNA negative conversion and those before treatment (P <0.05 or P<0.01 ),and serum levels of serum thyroid stimulating hormone (TSH),aspartate aminotransferase (AST),alanine aminotransferase (ALT),prothrombin time (PT)and total bilirubin (TBIL)were significant lower in those with HBV-DNA negative conversion than those without HBV-DNA negative conversion and those before treatment (P <0.05 or P <0.01 ).There was no serious adverse reaction reported in the observation group.Conclusion:ETV is effective and safe to improve the serum levels of thyroid hormone and liver func-tion in patients with hepatitis B virus-related compensated cirrhosis.