CAJ | 학술논문

目的：了解核苷类抗病毒药物治疗乙型肝炎肝硬化的近期疗效及其安全性。方法：选取江苏省泗洪县分金亭医院2009年1月至2011年1月收治的50例乙型肝炎肝硬化患者作为对照组，采取保守治疗；2011年1月至2013年1月收治的100例乙型肝炎肝硬化患者作为观察组，将其随机分为A、B、C3个亚组，分别接受拉米夫定、阿德福韦酯和恩替卡韦治疗。观察并比较4组患者治疗前后肝功能指标[谷丙转氨酶（ ALT）、谷草转氨酶（ AST）、总胆红素（ TBIL）、清蛋白（ ALB）]、凝血酶原时间活动度（ PTA）及肝纤维化指标[透明质酸（ HA）、层黏蛋白（ LN）、Ⅲ型前胶原（ PC－Ⅲ）、Ⅳ型胶原（Ⅳ－C）]、HBV－DNA转阴率及HBeAg血清转换率的变化情况。结果：治疗后4组患者肝功能指标、肝纤维化指标均较治疗前明显改善，A、B、C 3亚组上述指标改善更明显，与对照组相比，差异具有统计学意义（P＜0．05），3亚组组间差异不具有统计学意义（P＞0．05）；观察组3亚组患者治疗后HBV－DNA转阴率和HBeAg血清转换率明显高于对照组，差异具有统计学意义（P＜0．05），3亚组组间比较差异无统计学意义（P＞0．05）。对观察组3亚组进行成本－效益分析，结果表明C亚组效价比C／E值最高（2538．0），与其他2组相比差异具有统计学意义（P＜0．05）。观察组3亚组患者仅出现肌肉疼痛和疲劳等轻微不良反应。结论：核苷类抗病毒药物在乙型肝炎肝硬化患者的治疗中效果显著，可有效改善患者的肝脏功能，阻止肝纤维化，安全性高，恩替卡韦可作为经济治疗的首选，值得在临床广泛推广应用。
목적：료해핵감류항병독약물치료을형간염간경화적근기료효급기안전성。방법：선취강소성사홍현분금정의원2009년1월지2011년1월수치적50례을형간염간경화환자작위대조조，채취보수치료；2011년1월지2013년1월수치적100례을형간염간경화환자작위관찰조，장기수궤분위A、B、C3개아조，분별접수랍미부정、아덕복위지화은체잡위치료。관찰병비교4조환자치료전후간공능지표[곡병전안매（ ALT）、곡초전안매（ AST）、총담홍소（ TBIL）、청단백（ ALB）]、응혈매원시간활동도（ PTA）급간섬유화지표[투명질산（ HA）、층점단백（ LN）、Ⅲ형전효원（ PC－Ⅲ）、Ⅳ형효원（Ⅳ－C）]、HBV－DNA전음솔급HBeAg혈청전환솔적변화정황。결과：치료후4조환자간공능지표、간섬유화지표균교치료전명현개선，A、B、C 3아조상술지표개선경명현，여대조조상비，차이구유통계학의의（P＜0．05），3아조조간차이불구유통계학의의（P＞0．05）；관찰조3아조환자치료후HBV－DNA전음솔화HBeAg혈청전환솔명현고우대조조，차이구유통계학의의（P＜0．05），3아조조간비교차이무통계학의의（P＞0．05）。대관찰조3아조진행성본－효익분석，결과표명C아조효개비C／E치최고（2538．0），여기타2조상비차이구유통계학의의（P＜0．05）。관찰조3아조환자부출현기육동통화피로등경미불량반응。결론：핵감류항병독약물재을형간염간경화환자적치료중효과현저，가유효개선환자적간장공능，조지간섬유화，안전성고，은체잡위가작위경제치료적수선，치득재림상엄범추엄응용。
OBJECTIVE:To evaluate the short-term efficacy and safety of nucleoside antiviral therapy for hepatitis B virus-associated cirrhosis.METHODS: 50 patients with liver cirrhosis treated in hospital from January 2009 to January 2011 were assigned to receive routine therapy ( control group); another 100 patients with hepatitis B virus-associated cirrhosis ( observation group) treated in our hospital from January 2011 to January 2013 were assigned to receive lamivudine ( subgroup A) , adefovir ( subgroup B) or entecavir ( subgroup C) .Four groups were observed and compared before and after treatment with regard to liver function [ alanine aminotransferase ( ALT ) , aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB)], prothrombin time activity (PTA), liver fibrosis [hyaluronic acid (HA), laminin (LN), Ⅲ procollagen (PC-Ⅲ), Ⅳ collagen (Ⅳ-C)], HBV-DNA negative rate and HBeAg seroconversion rate.RESULTS: After treatment, the liver function and liver fibrosis in all of the four groups improved significantly, much as in three subgroups ( group A, B and C ) , showing statistically significant differences between the observation group ( three subgroups ) and the control group ( P<0.05 ) , yet the differences among the three subgroups were not statistically significant ( P >0.05 ); HBV-DNA negative rate and HBeAg seroconversion rates in three subgroups were significantly higher than in the control group after treatment and the differences were statistically significant ( P<0.05 ) , yet the differences were not statistically significant among three subgroups ( P>0.05 ) .The cost-effectiveness analysis on the three subgroups showed that subgroup C took the lead in C/E value ( 2538.0 ) , showing statistically significant differences as compared with the other two subgroups ( P <0.05 ) .The three subgroups in the observation group presented with only mild adverse drug reactions such as myalgia and mild fatigue.CONCLUSION:Nucleoside antiviral therapy is safe and effective for patients with hepatitis B virus-associated cirrhosis in that which can effectively improve patients'liver function and prevent liver fibrosis; entecavir can be used as the preferred choice economically, and which is worthy of popularization in clinical application.