血清M2BPGi在慢性丙型肝炎抗病毒治疗中的变化

发布时间：2018-06-23 10:08

  本文选题：慢性丙型肝炎 + 肝纤维化　； 参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:研究血清M2BPGi在直接抗病毒药物(direct-acting antiviral agents,DAA)联合聚乙二醇干扰素(pegylated interferon)(DAA+IFN)及直接抗病毒药物(DAA)治疗慢性丙型肝炎过程中的变化及差异,以及与其他生化指标的相关性。研究方法:经门诊筛查符合入组条件的患者,参照《丙型肝炎防治指南(2015年更新版)》诊断标准,明确诊断慢性丙型肝炎,并排除其他病毒感染、自身免疫性肝炎、药物性肝损伤、酒精性肝炎、肝癌。入组患者签订知情同意书及自愿书;由临床药理基地医生及护士定期向患者发放药物及评估患者用药情况;患者按实验设计按时服药,与医生约定时间定期回访及复查。患者血常规、肝功能、肝纤维化扫描在随访时定期检测,并留取样本检测治疗过程中M2BPGi水平。通过SPSS软件应用独立样本mann-whitney U检验、相关变量wilcoxon检验和卡方检验对数据进行统计学分析。研究结果:1、经抗病毒治疗达到持续性病毒学应答后,DAA组与DAA+IFN组AST、ALT、APRI、M2BPGi的中位值均有所下降(p0.05),DAA组治疗前后中位值分别为:AST50.39(16,119)、23.33(12,65),ALT 50.39(16,119)、20.2(9,93),APRI 0.931(0.17,4.96)、0.413(0.11,1.74),M2BPGi 2.472(0.43,12.96)、0.778(0.22,3.51);DAA+IFN组分别为:AST 48.44(19,106)、28.78(14,66),ALT 64.78(18,152)、18.94(0,61),APRI 0.734(0.20,1.86)、0.423(0.17,1.15),M2BPGi 1.525(0.59,4.13)、0.800(0.36,1.46);两组下降的变化均具有统计学意义(p0.05)。2、DAA+IFN治疗组与DAA治疗组在治疗结束时与基线水平的差值M2BPGi、ALB、PLT、APRI、FIB-4差异有统计学意义(p0.05),其中DAA+IFN组M2BPGi、APRI、FIB-4较基线时上升,而DAA组较基线时下降;AST、ALT、ALP两组较基线时均有所下降,两组之间无明显统计学差异(p0.05)。达到病毒学应答后12周后,DAA组M2BPGi、FIB-4下降程度较DAA+IFN组明显(p0.05);AST、ALT、APRI两组较基线时均有所下降,两组之间无明显统计学差异(p0.05)。3、DAA组血清M2BPGi水平整体基本均呈缓慢下降趋势。DAA+IFN组血清中M2BPGi基本上均呈上升后下降的趋势,大约在12周时达到最大值,停药后快速下降。4、经过单因素分析,血清M2BPGi水平与患者AST、ALT、APRI、FIB-4有相关性(P0.001),与纤维化评估指标APRI、FIB-4相关性较强,相关系数分别为0.546、0.528。经线性回归多因素分析,调整混杂因素后,AST(ES=-0.041,p0.009)、ALT(ES=-0.019,p0.003)是M2BPGi的独立影响因素。对基线水平M2BPGi与Fibro Scan相关性分析,相关系数为r=0.685(p0.05)。结论:1、DAA治疗组治疗过程中血清M2BPGi整体呈缓慢下降趋势;DAA+IFN治疗组治疗过程中血清M2BPGi整体上呈上升后下降趋势;血清M2BPGi可能反映抗丙肝病毒过程中肝脏轻度炎症变化。2、在达到持续性病毒学应答后12周后,DAA治疗组与DAA+IFN治疗组APRI、M2BPGi的中位值均下降,可能反应了治疗后肝纤维化水平的好转。两组比较时M2BPGi下降值存在差异而APRI无明显差异,可能说明M2BPGi较APRI更为敏感。
[Abstract]:Objective: to study the changes and differences of serum M2BPGi in the treatment of chronic hepatitis C with direct antiviral drugs (direct-acting antiviral agentsl) combined with polyethylene glycol interferon (pegylated interferon) (DAA) and direct antiviral drugs (DAA), as well as their correlation with other biochemical indexes. Methods: according to the guidelines for the prevention and treatment of hepatitis C (2015 update), the diagnosis criteria for chronic hepatitis C and other viral infections, autoimmune hepatitis, were clearly diagnosed, and other viral infections were excluded, according to the criteria of diagnosis and treatment of chronic hepatitis C, according to the guidelines for prevention and treatment of hepatitis C (updated in 2015). Drug induced liver injury, alcoholic hepatitis, liver cancer. The patients sign informed consent and voluntary letter of consent; doctors and nurses in clinical pharmacology base regularly distribute drugs to patients and evaluate the situation of patients; patients take drugs regularly according to experimental design, visit and review regularly with doctors. Blood routine examination, liver function, liver fibrosis scan were regularly detected during follow-up, and M _ 2 BPGI levels were detected during treatment. The data were analyzed by mann-whitney U test, wilcoxon test and chi-square test. 鐮旂┒缁撴灉:1,缁忔姉鐥呮瘨娌荤枟杈惧埌鎸佺画鎬х梾姣掑�﹀簲绛斿悾�

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