CAJ | 학술논문

目的：观察比较恩替卡韦治疗乙型肝炎肝硬化与慢性乙型肝炎患者96周的疗效。方法收集初治的乙型肝炎肝硬化患者71例（肝硬化组），慢性乙型肝炎患者89例（乙型肝炎组），均给予恩替卡韦0．5 mg，每日1次，口服治疗，持续抗病毒治疗96周，观察两组患者在治疗前、治疗第12、24、48、96周时病毒学、血清学、生物化学指标、出凝血时间、Child-Pugh积分及肾功能等变化情况。结果①恩替卡韦治疗后，两组患者乙型肝炎病毒核糖核酸（HBV DNA）、丙氨酸转氨酶（ALT）水平均较治疗前明显下降，发生乙型肝炎 e抗原（HBeAg）阴转及血清学转换的例数逐渐增加，但两组各时间点比较，差异均无统计学意义。②肝储备功能方面，恩替卡韦治疗后，两组患者白蛋白、总胆红素、凝血酶原时间均有不同程度改善，随着治疗的延长，白蛋白不断升高，总胆红素持续下降，凝血酶原时间减小，两组患者治疗48及96周白蛋白、总胆红素、凝血酶原时间及Child-Pugh积分与基线值比较，差异均有统计学意义（P＜0．05或＜0．01）。组间比较显示，白蛋白升高水平、总胆红素及凝血酶原时间下降水平在肝硬化失代偿组最高，肝硬化代偿组次之，慢性乙型肝炎组最低，差异均具有统计学意义。③两组患者治疗过程中，均未出现血清肌酐增高超过正常参考值范围情况。结论应用恩替卡韦抗病毒治疗，乙型肝炎肝硬化患者的病毒学、血清学及生化学应答均与慢性乙型肝炎患者相似，同时抗病毒治疗能明显改善各阶段乙型肝炎患者肝储备功能，其中乙型肝炎肝硬化失代偿期患者最为显著。
목적：관찰비교은체잡위치료을형간염간경화여만성을형간염환자96주적료효。방법수집초치적을형간염간경화환자71례（간경화조），만성을형간염환자89례（을형간염조），균급여은체잡위0．5 mg，매일1차，구복치료，지속항병독치료96주，관찰량조환자재치료전、치료제12、24、48、96주시병독학、혈청학、생물화학지표、출응혈시간、Child-Pugh적분급신공능등변화정황。결과①은체잡위치료후，량조환자을형간염병독핵당핵산（HBV DNA）、병안산전안매（ALT）수평균교치료전명현하강，발생을형간염 e항원（HBeAg）음전급혈청학전환적례수축점증가，단량조각시간점비교，차이균무통계학의의。②간저비공능방면，은체잡위치료후，량조환자백단백、총담홍소、응혈매원시간균유불동정도개선，수착치료적연장，백단백불단승고，총담홍소지속하강，응혈매원시간감소，량조환자치료48급96주백단백、총담홍소、응혈매원시간급Child-Pugh적분여기선치비교，차이균유통계학의의（P＜0．05혹＜0．01）。조간비교현시，백단백승고수평、총담홍소급응혈매원시간하강수평재간경화실대상조최고，간경화대상조차지，만성을형간염조최저，차이균구유통계학의의。③량조환자치료과정중，균미출현혈청기항증고초과정상삼고치범위정황。결론응용은체잡위항병독치료，을형간염간경화환자적병독학、혈청학급생화학응답균여만성을형간염환자상사，동시항병독치료능명현개선각계단을형간염환자간저비공능，기중을형간염간경화실대상기환자최위현저。
Objective To compare the antiviral efficacy of entecavir for 96 weeks in patients with hepatitis B virus-related cirrhosis and chronic hepatitis B.Methods A total of 160 cases were collected,including 71 patients with hepatitis B virus-related cirrhosis and 89 patients with chronic hepatitis B,who had not previously received a nucleoside analogue,all the patients received 0.5 mg of entecavir once daily for 96 weeks.Virological,serological,biochemical markers,prothrombin time,Child-Pugh scores and renal function were observed at different time during the course of therapy.Results ①The levels of HBV DNA and ALT decreased obviously,and the number of patients with HBeAg seroconversion increased gradually after ETV therapy in both groups,however there were no significant difference between two groups at different time.② With the treatment prolonged,the serum albumin,total bilirubin,and prothrombin time were improved to some extent in both groups.The serum albumin,total bilirubin,prothrombin time and Child-Pugh score were markedly higher at week 48 and 96 compared with their baseline statistically.By group analysis,the increased margins of serum albumin,the decreased margins of total bilirubin,prothrombin time,Child-Pugh score from the baseline were the highest in the decompensated cirrhosis group and higher in the compensated cirrhosis group than the chronic hepatitis group.③There was no evidence of serum creatinine increasing above the upper limit of normal during treatment in two groups.Conclusion The antiviral efficacy in patients with hepatitis B liver cirrhosis and chronic hepatitis B on virology,serology and biochemical responses are similar by entecavir. Meanwhile,antiviral treatment can improve hepatic reserve at all stages and was most beneficial and significant for decompensated cirrhosis.