阿德福韦酯联合恩替卡韦治疗老年失代偿期乙型肝炎相关肝硬化患者疗效及血清细胞因子水平变化

摘要

目的 观察联合应用阿德福韦酯与恩替卡韦治疗老年失代偿期乙型肝炎肝硬化患者疗效及其对血清细胞因子水平的影响.方法 2014年1月～ 2015年1月我院收治的84例老年失代偿期乙型肝炎肝硬化患者被作为研究对象,并被随机分为观察组42例和对照组42例.观察组患者口服阿德福韦酯联合恩替卡韦治疗,对照组患者服用阿德福韦酯进行治疗.治疗48周后对比两组患者肝功能指标、HBV DNA转阴率以及血清TNF-α和IL-10水平变化.结果 在治疗48周末,观察组和对照组患者血清总红胆素分别为(28.3±4.2)μmol/L和(47.4±6.2)μmol/L,谷丙转氨酶分别为(71.3±19.8)U/L和(109.7±16.1)U/L,谷草转氨酶分别为(65.3±17.4)U/L和(98.3±21.6)U/L,血清白蛋白分别为(38.4±4.3)g/L和(33.2±2.8)g/L,凝血酶原时间国际标准化比值(INR)分别为(0.98±0.10)和(1.14±0.07),差异均有统计学意义(P＜0.05);在治疗24周和48周,观察组患者HBV DNA转阴率分别为35.7％和61.9％,显著高于对照组的13.0％和33.3％(P＜0.05);观察组与对照组患者血清TNFα水平分别为(22.4±16.8)pg/ml和(32.8±22.3)pg/ml,IL-10分别为(21.2±3.6)pg/ml和(16.2±3.4)pg/ml,差异均有统计学意义(P＜0.05).结论 阿德福韦酯联合恩替卡韦较阿德福韦酯单药治疗能够更显著改善老年失代偿期乙型肝炎肝硬化患者肝功能,提高血清HBV DNA转阴率,并降低炎症细胞因子水平.%Objectives To investigate the efficacy of combination of adefovir dipivoxil and entecavir in treatment of elderly patients with decompensated hepttitis B-induced liver cirrhosis.Methods A total of 84 elderly patients with decompensated hepttitis B-induced liver cirrhosis in our hospital between January 2014 and January 2015 were recruited in this study.Patients were divided into two groups,and 42 patients were treated with adefovir dipivoxil combined with entecavir,and another 42 patients in the control group were treated with adefovir dipivoxil alone.The liver function index and negative rate of serum HBV DNA were compared.Serum tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were measured by ELISA.Results At the end of 48 week treatment,serum levels of total bilirubin in combination and in adefovir-treated groups were (28.3±4.2) μmol/L and (47.4±6.2) μmol/L,ALT were (71.3±19.8) U/L and (109.7±16.1) U/L,AST were (65.3±17.4) U/L and(98.3±21.6) U/L,respectively,all having statistically significant differences(P＜0.05);the negative rates of serum HBV DNA at week 24 and week 48 in combination group was 35.7％ and 61.9％,respectively,both much higher than (13.0％ and 33.3％,P＜0.05) in the adefovir-treated group;serum levels of TNF-α in combination and adefovir-treated group after treatment were(22.4±16.8) pg/ml and (32.8±22.3) pg/ml,respectively,and serum levels of IL-10 were (21.2±3.6) pg/ml and (16.2±3.4) pg/ml,respectively,both having statistically significant differences (P＜0.05).Conclusion Adefovir dipivoxil combined with entecavir can improve the liver function index and increase negative rates of serum HBV DNA in elderly patients with decompensated hepatitis B-induced liver cirrhosis,which is obviously superior to adefovir dipivoxil therapy alone.