CAJ | 학술논문

目的：观察恩替卡韦治疗肝源性糖尿病对肝纤维化指标的影响。方法选择2008年6月至2013年8月青岛市传染病医院收治的乙型肝炎肝硬化伴肝源性糖尿病患者98例，分为治疗组和对照组各49例，所有患者均给予糖尿病饮食及综合护肝、对症、支持治疗。治疗组给予恩替卡韦0．5 mg，1次／d，口服，52周后观察血清肝纤维化及FibroScan检测的肝硬度（LSM）值的差异。计量资料两组间比较采用t检验，计数资料组间比较采用χ2检验。结果治疗52周后治疗组血清肝纤维化的4项指标、层黏连蛋白、Ⅳ型胶原、透明质酸、Ⅲ型前胶原蛋白较对照组差异有统计学意义（t＝2．71，P＜0．01；t＝3．53，P＜0．01；t＝2．34，P＜0．05；t＝2.28，P＜0．05）。两组病毒学应答率和糖尿病控制率差异均有统计学意义（χ2值分别为12.69，7.14，P值均＜0.01）。LSM值降低显著（t＝3．22，P＜0．01），同时肝功能指标（TBil、ALT、Alb）和空腹血糖等指标较对照组好转，差异有统计学意义（t＝5.53，P＜0.01；t＝4.73，P＜0.01；t＝2.42，P＜0.05；t＝16.01，P＜0.01）。结论恩替卡韦治疗HBV DNA阳性的乙型肝炎肝硬化伴肝源性，能有效降低其血清肝纤维化指标及LSM值，亦能有效改善HBV DNA复制、血糖、肝功能等指标，具有较好的临床效果。
목적：관찰은체잡위치료간원성당뇨병대간섬유화지표적영향。방법선택2008년6월지2013년8월청도시전염병의원수치적을형간염간경화반간원성당뇨병환자98례，분위치료조화대조조각49례，소유환자균급여당뇨병음식급종합호간、대증、지지치료。치료조급여은체잡위0．5 mg，1차／d，구복，52주후관찰혈청간섬유화급FibroScan검측적간경도（LSM）치적차이。계량자료량조간비교채용t검험，계수자료조간비교채용χ2검험。결과치료52주후치료조혈청간섬유화적4항지표、층점련단백、Ⅳ형효원、투명질산、Ⅲ형전효원단백교대조조차이유통계학의의（t＝2．71，P＜0．01；t＝3．53，P＜0．01；t＝2．34，P＜0．05；t＝2.28，P＜0．05）。량조병독학응답솔화당뇨병공제솔차이균유통계학의의（χ2치분별위12.69，7.14，P치균＜0.01）。LSM치강저현저（t＝3．22，P＜0．01），동시간공능지표（TBil、ALT、Alb）화공복혈당등지표교대조조호전，차이유통계학의의（t＝5.53，P＜0.01；t＝4.73，P＜0.01；t＝2.42，P＜0.05；t＝16.01，P＜0.01）。결론은체잡위치료HBV DNA양성적을형간염간경화반간원성，능유효강저기혈청간섬유화지표급LSM치，역능유효개선HBV DNA복제、혈당、간공능등지표，구유교호적림상효과。
Objective To investigate the effects of entecavir on liver fibrosis indices in patients with hepatogenous diabetes.Methods A total of 98 patients,who were admitted to our hospital from June 2008 to August 2013,were diagnosed with hepatitis B cirrhosis complicated by hepatogenous diabetes,and were randomly and equally divided into treatment group and control group.All patients were given diabetic diet,as well as liver protection,symptomatic treatment,and supportive care.The treatment group was orally administered entecavir 0.5 mg once daily for 52 weeks.Live fibrosis indices and FibroScan value were analyzed after treatment.Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made byχ2 test.Results Compared with the control group,the treat-ment group had significantly lower levels of laminin,type Ⅳ collagen,hyaluronic acid,and type Ⅲ procollagen (t=2.71,P<0.01;t=3.53,P<0.01;t=2.34,P<0.05;t=2.28,P<0.05),a significantly lower FibroScan value (t=3.22,P<0.01),a significantly higher serum HBV DNA clearance rate (χ2 =12.69,P<0.01),a significantly lower blood glucose level (t=16.01,P<0.01),signifi-cantly lower levels of total bilirubin and alanine aminotransferase (t=5.53,P<0.01;t=4.73,P<0.01),and a significantly higher al-bumin level (t=2.42,P<0.05).Conclusion Entecavir leads to improvements in liver fibrosis indices,FibroScan value,viral DNA rep-lication,blood glucose,and liver function indices and has good efficacy in HBV DNA-positive hepatitis B cirrhosis patients complicated by hepatogenous diabetes.