恩替卡韦联合胸腺肽治疗HBeAg阳性慢性乙型肝炎患者的临床效果

黄玲; 宁惠明; 徐燕华; 汤群; 欧强

doi:10.3969/j.issn.1001-5256.2016.11.011

恩替卡韦联合胸腺肽治疗HBeAg阳性慢性乙型肝炎患者的临床效果

DOI: 10.3969/j.issn.1001-5256.2016.11.011

上海市第八人民医院

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- 出版日期: 2016-11-20

Clinical effect of entecavir combined with thymosin in treatment of HBe Ag-positive hepatitis B patients

摘要

摘要:
目的研究HBe Ag阳性慢性乙型肝炎（CHB）患者应用恩替卡韦（ETV）联合胸腺肽治疗的临床疗效。方法纳入2012年3月-2015年3月于上海市第八人民医院传染病科就诊的HBe Ag阳性CHB患者108例,根据平行、单盲、随机对照原则分为对照组（54例）和观察组（54例）。两组均接受内科综合治疗,对照组单用ETV治疗,观察组应用ETV联合胸腺肽治疗。对比两组肝功能指标、病毒学指标、免疫指标及肝纤维化指标变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗48周后,观察组的肝功能指标（Alb/Glo、ALT、AST、TBil）与对照组比较差异均有统计学意义[（1.73±0.57）vs（1.50±0.51）、（42.58±14.32）U/L vs（54.26±18.78）U/L、（35.79±10.33）U/L vs（49.97±17.84）U/L、（18.89±6.02）μmol/L vs（25.24±9.06）μmol/L,t值分别为2.210、3.634、5.055、4.290,P值均<0.05];治疗48周后,观察组的肝纤维化指标（层黏连蛋白、透明质酸、Ⅳ...
- 肝炎,乙型,慢性 /
- 肝炎e抗原,乙型 /
- 恩替卡韦 /
- 胸腺肽 /
- 对比研究
Abstract:
Objective To investigate the clinical effect of entecavir( ETV) combined with thymosin in the treatment of HBe Ag- positive chronic hepatitis B( CHB) patients. Methods A total of 108 HBe Ag- positive CHB patients who were treated in Department of Infectious Diseases in our hospital from March 2012 to March 2015 were enrolled,and according to the parallel,single- blind,randomized controlled principles,the patients were divided into control group( 54 patients) and observation group( 54 patients). The patients in both groups were given comprehensive medical treatment; the patients in the control group were treated with ETV alone,and those in the observation group were treated with ETV combined with thymosin. The changes in liver function parameters,virological parameters,immune indices,and liver fibrosis indicators were compared between the two group. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver function parameters albumin / globulin ratio( 1. 73 ± 0. 57 vs 1. 50 ± 0. 51,t =2. 210,P < 0. 05),alanine aminotransferase( 42. 58 ± 14. 32 U / L vs 54. 26 ± 18. 78 U / L,t = 3. 634,P < 0. 05),aspartate aminotransferase( 35. 79 ± 10. 33 U / L vs 49. 97 ± 17. 84 U / L,t = 5. 055,P < 0. 05),and total bilirubin( 18. 89 ± 6. 02 μmol / L vs 25. 24 ± 9. 06μmol /L,t = 4. 290,P < 0. 05). After 48 weeks of treatment,there were significant differences between the observation group and the control group in the liver fibrosis indicators laminin( 65. 34 ± 11. 02 ng / ml vs 102. 57 ± 16. 41 ng / ml,t = 13. 840,P < 0. 001),hyaluronic acid( 91. 68 ± 11. 53 ng / ml vs 151. 23 ± 16. 71 ng / ml,t = 21. 555,P < 0. 001),type IV collagen( 81. 02 ± 12. 64 μg / ml vs 118. 47 ±18. 01 μg / ml,t = 12. 507,P < 0. 001),and procollagen III( 70. 44 ± 13. 06 μg / ml vs 91. 57 ± 17. 16 μg / ml,t = 7. 200,P < 0. 001). At weeks 12,24,and 48 of treatment,the observation group had significantly higher HBe Ag clearance rates than the control group( 29. 63% /46. 30% /57. 41% vs 12. 96% /22. 22% /25. 93%,χ2= 4. 475,6. 948,and 11. 009,all P < 0. 05). After 48 weeks of treatment,compared with the control group,the observation group had a significantly lower serum level of interleukin- 4( 2. 69 ± 1. 23 pg / ml vs 4. 38 ±1. 44 pg / ml,t = 6. 558,P < 0. 001) and a significantly higher level of interferonγ( 1. 82 ± 0. 89 pg / ml vs 1. 12 ± 0. 56 pg / ml,t = 4. 812,P < 0. 001). There was no significant difference in the incidence rate of adverse events between the observation group and the control group( 3. 70% vs 1. 85%,χ2= 0. 343,P = 0. 558). Conclusion In HBeA g- positive CHB patients,ETV combined with thymosin can promote the recovery of liver function,regulate immune function,improve HBeA g clearance rate,and inhibit the process of liver fibrosis.
- hepatitis B,chronic /
- hepatitis B e antigen /
- entecavir /
- thymosin /
- comparative study

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参考文献(19)

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