恩替卡韦治疗失代偿期乙肝肝硬化疗效观察

发布时间：2018-01-09 20:35

本文关键词：恩替卡韦治疗失代偿期乙肝肝硬化疗效观察　出处：《临床合理用药杂志》2016年07期 　论文类型：期刊论文

【摘要】：目的观察恩替卡韦治疗失代偿期乙肝肝硬化的长期治疗效果。方法选择80例失代偿期乙肝肝硬化患者入院后在保肝、利尿等基础治疗上,每日睡前给予恩替卡韦治疗,连续治疗48周。观察患者治疗前后临床症状变化情况及用药不良反应,在患者治疗前及治疗24周、48周进行肝功能检查,比较患者肝功能指标,HBe Ag、HBV血清标志物,Child-Pugh评分,检测HBV-DNA阴转率。结果患者服药治疗12周后,厌食、恶心、乏力等症状开始好转;服药24周后,腹胀减轻,腹水开始消退;治疗48周后所有患者均存活,有4例患者于治疗期间证实发展为肝癌,经手术切除后继续服用恩替卡韦,其他患者症状明显缓解或消退。经恩替卡韦治疗后,患者的TBIL、ALT及AST含量明显下降,ALB含量有所上升,各项肝功能指标均明显改善(P0.05)。采用恩替卡韦治疗后,48名HBe Ag阳性患者中,24周转阴率为56.25%,48周转阴率为79.17%;平均HBV DNA由(6.2±1.4)log copies/ml下降至(3.1±0.9)logcopies/ml,48周后HBV DNA转阴率为93.75%;Child-Pugh评分下降至(5.6±0.7)分。治疗前后HBV血清指标及Child-Pugh评分变化显著(P0.05)。恩替卡韦治疗前,并发症总个数为99例,治疗后,总并发症例数下降至39例,减少约60.6%;各类并发症中上消化道出血、肝性脑病、慢性肝衰竭并发症在治疗48周均消失,腹水病例由62例减少至37例,腹膜炎由15例减少为2例。治疗前后并发症发生率差异具有统计学意义(P0.05)。80名患者治疗期间无明显不良症状,10例患者出现轻微头晕、恶心等不适反应,无线粒体毒性反应病例发生。结论恩替卡韦治疗失代偿期乙肝肝硬化疗效确切,可有效改善代偿期乙肝肝硬化患者肝功能状况,减轻或阻止病情进程,同时减少腹水及腹膜炎等并发症的发生,无严重不良反应,值得临床推广与应用。
[Abstract]:Objective to observe the long-term efficacy of entecavir in the treatment of decompensated hepatitis B cirrhosis. Methods 80 patients with decompensated hepatitis B cirrhosis were enrolled in the treatment of liver preservation and diuretic therapy. Patients were treated with entecavir daily for 48 weeks. The changes of clinical symptoms and adverse drug reactions were observed before and after treatment. Liver function was examined before and after 24 weeks of treatment. The liver function index and Child-Pugh score were compared. Results after 12 weeks of treatment, patients were anorexia. Nausea, fatigue and other symptoms began to improve; After taking medicine for 24 weeks, abdominal distension was alleviated and ascites began to recede. After 48 weeks of treatment, all patients survived, and 4 patients were confirmed to develop liver cancer during the treatment period, and continued to take entecavir after surgical resection. The symptoms of other patients were obviously relieved or subsided, and after treatment with entecavir. The contents of alt and AST in TBILT were decreased significantly and the contents of ALB were increased, and the liver function indexes were improved significantly (P 0.05). After the treatment with entecavir, the liver function of the patients was significantly improved after treatment with entecavir. In 48 patients with HBe Ag positive, the rate of turning negative in 24 weeks was 56.25 weeks and the rate of turning negative in 48 weeks was 79.17; The average HBV DNA decreased from 6.2 卤1.4 log copies/ml to 3.1 卤0.9g log copi / ml. After 48 weeks, the negative rate of HBV DNA was 93.75; The Child-Pugh score decreased to 5.6 卤0.7. The changes of serum HBV and Child-Pugh scores were significant before and after treatment (P 0.05). The total number of complications was 99 cases. After treatment, the total number of complications decreased to 39 cases, the reduction was about 60.6%; Among the various complications, hemorrhage of upper digestive tract, hepatic encephalopathy and chronic hepatic failure disappeared in 48 weeks, and ascites cases decreased from 62 cases to 37 cases. Peritonitis was reduced from 15 cases to 2 cases. There was significant difference in the incidence of complications before and after treatment in 10 patients with mild dizziness. Conclusion entecavir is effective in the treatment of decompensated hepatitis B cirrhosis and can effectively improve the liver function of patients with compensatory hepatitis B cirrhosis. To reduce or prevent the progression of the disease, and reduce the incidence of ascites and peritonitis and other complications, there is no serious adverse reactions, worthy of clinical promotion and application.
【作者单位】：江苏省盐城市第三人民医院南分院;
【分类号】：R575.2;R512.62
【正文快照】： 乙肝是世界范围内的健康问题,全球乙肝病毒携带者超过3.5亿,乙肝病毒感染者中有25%以上的患者将发展为肝硬化[1]。失代偿期乙肝肝硬化[2]是乙肝的终末期阶段,临床伴有消化道出血、腹水、肝肾综合征等并发症,5年病死率高达85%。毫无疑问,失代偿期乙肝肝硬化将严重影响患者生存

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