CAJ | 학술논문

目的：探讨抗病毒治疗对血清HBV DNA阳性的门脉高压症患者术后临床转归的影响。方法将89例HBV DNA阳性乙型肝炎肝硬化伴门静脉高压症患者随机分成治疗组48例，采用选择性断流联合恩替卡韦治疗和对照组41例，采用单纯手术治疗。常规检测肝功能、HBV DNA定量、Child-Pugh评分和肝纤维化指标。结果在术后1 m和3 m时，治疗组患者血清HBV DNA水平分别为（5.79±1.78） lgcopies/L和（4.24±1.61） lgcopies/L，显著低于对照组[分别为（7.90±1.83） lgcopies/L和（6.46±1.43）lgcopies/L，P<0.05]；治疗组患者血清ALT和总胆红素较对照组降低，白蛋白升高；治疗组1 a生存率为93.75%，3 a生存率为75%，对照组患者1 a生存率为87.92%，3 a生存率为68.30%，治疗组显著高于对照组（P＜0.05）。结论抗病毒治疗可以促进HBV DNA阳性的门脉高压症患者术后肝功能恢复，改善患者预后。
목적：탐토항병독치료대혈청HBV DNA양성적문맥고압증환자술후림상전귀적영향。방법장89례HBV DNA양성을형간염간경화반문정맥고압증환자수궤분성치료조48례，채용선택성단류연합은체잡위치료화대조조41례，채용단순수술치료。상규검측간공능、HBV DNA정량、Child-Pugh평분화간섬유화지표。결과재술후1 m화3 m시，치료조환자혈청HBV DNA수평분별위（5.79±1.78） lgcopies/L화（4.24±1.61） lgcopies/L，현저저우대조조[분별위（7.90±1.83） lgcopies/L화（6.46±1.43）lgcopies/L，P<0.05]；치료조환자혈청ALT화총담홍소교대조조강저，백단백승고；치료조1 a생존솔위93.75%，3 a생존솔위75%，대조조환자1 a생존솔위87.92%，3 a생존솔위68.30%，치료조현저고우대조조（P＜0.05）。결론항병독치료가이촉진HBV DNA양성적문맥고압증환자술후간공능회복，개선환자예후。
Objective To explore the effect of antiviral therapy on the clinical postoperative prognosis of patients with serum HBV DNA-positive hepatitis B related cirrhosis and portal hypertension (PH). Methods 89 patients with serum HBV DNA positive liver cirrhosis and PH were randomly divided into intervention group (n=49) receiving selected splenectomy and entecavir,and control group (n=41) receiving selected splenectomy alone. The liver function tests,serum HBV DNA levels,Child-Pugh scores,liver fibrosis markers were routinely obtained, and the survival rates were observed. Results At the end of 1 month and 3 month after surgery,the serum HBV DNA levels in intervention group were (5.79±1.78) lgcopies/L and (4.24±1.61) lgcopies/L,respectively,while it didn’t change in the control group (P<0.01);The serum alanine aminotransferase and total bilirubin levels in in-tervention group decreased,albumin increased as compared to those in control (P<0.01);the survival rates at 1 a and 3 a in invention group were 93.7% and 75.0%,much higher than 87.9% and 68.3%,in the control (P<0.05). Conclusions Antiviral therapy after selected splenectomy in PH patients with positive HBV DNA can promote the 1iver function recovery and better clinical prognosis.