CAJ | 학술논문

目的分析慢性乙型肝炎患者经规范核苷(酸)类似物治疗获得完全病毒学应答但生物化学应答不佳的原因,并在原有治疗基础上对合并脂肪肝患者在改变生活方式的基础上加用双环醇片,观察其疗效和安全性.方法收集40例规范核苷(酸)类似物抗病毒治疗2年以上(＞24 ～＜61个月),病毒学完全应答但生物化学应答不佳的慢性乙型肝炎患者进行肝组织病理学检查,分析产生原因,对其中27例合并脂肪肝的患者在抗病毒和改变生活方式基础上加用双环醇治疗48周,观察治疗前后生物化学各项指标和肝纤维化指标的变化.患者纤维化分期危险因素的分析用二分类logistic多元回归分析;肝功能生物化学指标资料的比较采用单组重复测量设计的方差分析,不同时间点均值的两两比较采用多重比较配对的t检验进行分析. 结果肝组织病理学检查结果显示40例患者中有不同程度肝细胞脂肪变者27例(69.23％),发现组织中脂肪变和炎症与肝纤维化严重程度相关(x 2=4.746,P=0.029;x 2=5.072,P=0.024),血清和组织中HBsAg水平与肝纤维化程度无相关性(x2=0.273,P=0.601;x2=0.020,P=0.887).改善生活方式并加用双环醇治疗的患者,生物化学应答率显著提高,ALT水平明显下降(F=58.045,P=0.000),血清谷胱甘肽过氧化物酶水平明显上升(t=15.109,P=0.000),丙二醛水平明显下降(t=-10.786,P=0.000);肝脏弹性测定硬度值下降(t=3.873,P=0.001;治疗前＜15 kPa者,t=2.255,P=0.036;治疗前＞15 kPa者,t=5.376,P=0.002).结论对慢性乙型肝炎患者经规范核苷(酸)类似物长期治疗后生物化学应答不佳的患者,应尽早考虑其他致病因素以便指导治疗.在改变生活方式的基础上加用双环醇对于慢性乙型肝炎合并脂肪肝导致的生物化学应答不佳的慢性乙型肝炎患者,有一定的疗效.
목적 분석만성을형간염환자경규범핵감(산)유사물치료획득완전병독학응답단생물화학응답불가적원인,병재원유치료기출상대합병지방간환자재개변생활방식적기출상가용쌍배순편,관찰기료효화안전성.방법 수집40례규범핵감(산)유사물항병독치료2년이상(＞24 ～＜61개월),병독학완전응답단생물화학응답불가적만성을형간염환자진행간조직병이학검사,분석산생원인,대기중27례합병지방간적환자재항병독화개변생활방식기출상가용쌍배순치료48주,관찰치료전후생물화학각항지표화간섬유화지표적변화.환자섬유화분기위험인소적분석용이분류logistic다원회귀분석;간공능생물화학지표자료적비교채용단조중복측량설계적방차분석,불동시간점균치적량량비교채용다중비교배대적t검험진행분석. 결과 간조직병이학검사결과현시40례환자중유불동정도간세포지방변자27례(69.23％),발현조직중지방변화염증여간섬유화엄중정도상관(x 2=4.746,P=0.029;x 2=5.072,P=0.024),혈청화조직중HBsAg수평여간섬유화정도무상관성(x2=0.273,P=0.601;x2=0.020,P=0.887).개선생활방식병가용쌍배순치료적환자,생물화학응답솔현저제고,ALT수평명현하강(F=58.045,P=0.000),혈청곡광감태과양화물매수평명현상승(t=15.109,P=0.000),병이철수평명현하강(t=-10.786,P=0.000);간장탄성측정경도치하강(t=3.873,P=0.001;치료전＜15 kPa자,t=2.255,P=0.036;치료전＞15 kPa자,t=5.376,P=0.002).결론 대만성을형간염환자경규범핵감(산)유사물장기치료후생물화학응답불가적환자,응진조고필기타치병인소이편지도치료.재개변생활방식적기출상가용쌍배순대우만성을형간염합병지방간도치적생물화학응답불가적만성을형간염환자,유일정적료효.
Objective To analyze the reason of biochemical suboptimal response in CHB patients with complete virological response after more than 2 years standard treatment with Nucleos(t)-ide analogs (NUCs).To evaluate the efficacy and safety profiles of bicyclol tablets plus on the basis of the original treatment and lifestyle intervention.in CHB patients complicated with fatty liver.Methods In 40 patients with chronic hepatitis B meeting the inclusion criteria,the liver biopsy was conducted.And patients complicated with fatty liver were treated with bicyclol tablets(25 mg,t.i.d) additional consecutive 48 weeks.The changes of serum biochemistry indexes and liver fibrosis index were observed before and after treatment.Results Among 40 patients,27 were complicated with fatty liver(69.23％),fatty degree in liver cell and liver inflammatory were closely related to the advanced fibrosis (x2 =4.746,P=0.029;x2 =5.072,P=0.024).The expression of HBsAg in serum and liver tissue showed no correlation with the advanced fibrosis (x2=0.273,P=0.601;x2 =0.020,P =0.887) After bicyclol tablets treatment,serum biochemistry of patients complicated with fatty liver significantly decreased (F=58.045,P =0.000),plasma GST-PX significantly increased (t=15.109,P =0.000),plasma MDA significantly decreased (t=-10.786,P=0.000);LSM significantly decreased (t=2.255,P=0.036;t =5.376,P =0.002).Conclusion For the antiviral purpose of guide treatment,CHB patients treated with Nucleos(t)-ide analogs (NUCs) with biochemical suboptimal response,other risk factors should be considered as early as possible.Bicyclol plus lifestyle intervention was effective for chronic hepatitis B combined fatty liver patients with poor biochemical responses.