摘要
目的观察恩替卡韦和阿德福韦酯治疗乙型病毒性肝炎(乙肝,HBV)相关肝硬化的疗效和对肾功能的影响,为监测和优化乙肝药物的使用提供依据。方法将110例乙肝相关肝硬化患者随机分为对照组55例和试验组55例。对照组口服替比夫定,每次600 mg,每日1次;试验组口服恩替卡韦,每次0.5 mg,每日1次,阿德福韦酯,每次10 mg,每日1次。2组治疗均持续48周。比较2组患者治疗前后乙肝DNA(HBV DNA)、病毒学、血清学应答水平、肝纤维化指标及肾小球滤过率(e GFR)的变化情况。结果治疗48周后,对照组和试验组HBV DNA水平分别降低4.73,5.32 log10U·m L^(-1)(P<0.05),对照组HBV DNA转阴率、乙肝e抗原(HBeAg)转阴率、血清谷丙转氨酶(ALT)复常率分别为69.09%,20.00%,85.45%;试验组HBV DNA转阴率、HBeAg转阴率、ALT复常率分别为74.55%,14.55%,78.18%。治疗后,对照组透明质酸(HA)和Ⅲ型前胶原(PCⅢ)分别为(140.20±20.65),(182.10±12.00)ng·m L^(-1),与治疗前相比,差异均有统计学意义(均P<0.05)。治疗后,试验组HA、层粘连蛋白、PCⅢ分别为(122.40±18.27),(130.90±13.62),(112.10±16.73)ng·m L^(-1),与治疗前相比,差异均有统计学意义(均P<0.05)。治疗后的试验组与对照组PCⅢ相比,差异有统计学意义(P<0.05)。治疗48周,对照组和试验组的eGFR分别为(112.00±16.17),(103.00±13.02)m L/1.73 m^2·min,差异无统计学意义(P>0.05)。2组治疗期间未见耐药、明显药物不良反应及肾功能变化。结论与替比夫定相比,恩替卡韦、阿德福韦酯联用对乙肝相关肝硬化患者的肝功能改善作用更强,替比夫定对肾功能的改善作用与恩替卡韦、阿德福韦酯联用无显著差异。
Objective To study the impact of entecavir(ETV） combined with adefovir dipivoxil(ADV） on efficacy and nephritic function in the treatment of patients with hepatitis B virus(HBV）-related cirrhosis,to provide the basis for monitoring and optimizing HBV drug.Methods A total of 110 patients who diagnosed with HBV-related cirrhosis were randomly divided into control group(n = 55） and treatment group(n = 55）. Control group was orally given telbivudine 600 mg,qd. Treatment group was given orally entecavir 0. 5 mg, qd,combined with adefovir dipivoxil 10 mg,qd. Both groups were lasted for48 weeks. The HBV DNA level,virologic,serologic and biochemical response,liver fibrosis index and e GFR levels before and after treatmentwere compared between the two groups. Results After 48 weeks treatment,HBV DNA levels were reduced 4. 73 log10 U·m L-1,5. 32 log10 U·m L-1 in control group and treatment group(P〈0. 05）. The HBV DNA negative conversion rate,HBe Ag negative conversion rate and alanine aminotransferase(ALT） normalization in control group were69. 09%,20. 00%,85. 45%,had no significant difference with those in treatment group,which were 74. 55%,14. 55% and 78. 18%. The levels of hyaluronic acid(HA） and procollagen type Ⅲ(PCⅢ） were(140. 20 ± 20. 65）,(182. 10 ± 12. 00） ng · m L-1 after treatment in control group,had significant difference with before treatment(P〈0. 05）. The levels of HA,laminin and PC Ⅲ in treatment group after treatment were(122. 40 ± 18. 27）,(130. 90 ± 13. 62）,(112. 10 ± 16. 73） ng·m L-1,had significant difference with before treatment(P〈0. 05）. The level of PC Ⅲ in treatment group had significant difference with control group after treatment(P〈0. 05）. After 48 weeks treatment,e GFR level in control group was(112. 00 ± 16. 17） m L/1. 73 m2·min,had no significant difference with those in treatment group,which were(103. 00 ± 13. 02） m L/1. 73 m2·min(P〈0. 05）. No obvious drug resistance,adverse drug reaction and renal function change were obs
作者
沈男男
王佳良
劳国琴
石夏莹
王伶
张谊芳
蒋杰
SHEN Nan - nan;WANG Jia - liang;LAO Guo - qin;SHI Xia - ying;WANG Ling;ZHANG Yi - fang;JIANG Jie(Department of Clinical Pharmacy, Shaoxing Municipal Hospital, Shaoxing 312000, Zhejiang Province, China)
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
2018年第10期1136-1139,共4页
The Chinese Journal of Clinical Pharmacology
基金
浙江省药学会医院药学专项科研基金资助项目(2016ZYY29)
绍兴市卫生计生科技创新计划基金资助项目(2016CX010)
