熊去氧胆酸联合阿德福韦酯治疗乙型肝炎肝硬化的效果观察
웅거양담산연합아덕복위지치료을형간염간경화적효과관찰
Effect of ursodeoxycholi acid combined with adefovir dipivoxil in treating hepatitis B cirrhosis
  • 万方数据
    中国医药 중국의약
    China Medicine
    2015年 11期 1618-1622 ,共5页

    袁剑峰%江应安%张翠芳%张志勇

    원검봉%강응안%장취방%장지용

    肝炎,乙型%肝硬化%熊去氧胆酸%阿德福韦酯%生活质量 肝炎,乙型%肝硬化%熊去氧膽痠%阿德福韋酯%生活質量
    간염,을형%간경화%웅거양담산%아덕복위지%생활질량
    Hepatitis,type B%Liver cirrhosis%Ursodeoxycholi acid%Adefovir dipivoxil%Quality of life
    目的 探讨熊去氧胆酸联合阿德福韦酯治疗乙型肝炎肝硬化的临床效果.方法 选取2010年10月至2014年12月在武汉大学人民医院感染性疾病科及黄石市中心医院感染性疾病科经肝穿刺活检以及血清检查确诊的失代偿期乙型肝炎肝硬化患者65例,采用随机数字表法分为观察组(33例)和对照组(32例),观察组患者口服阿德福韦酯胶囊(10 mg/d,1次/d)和熊去氧胆酸胶囊(250 mg/片,2次/d)治疗,对照组单纯口服阿德福韦酯胶囊(10 mg/d,1次/d)治疗.2组基本疗程为48周.比较2组治疗前及治疗12、24、48周后的乙型肝炎病毒(HBV) DNA含量、血清丙氨酸转氨酶(ALT)、总胆红素、γ谷氨酰转肽酶(γ-GT)、碱性磷酸酶(ALP)、血清球蛋白(GLO)水平及慢性肝病问卷得分情况(包括腹部症状、困乏、全身症状、活动能力、情感功能、焦虑),和治疗12、24、48周后的乙型肝炎e抗原(HBeAg)转阴率、HBV DNA转阴率及腹腔积液消失情况.结果 2组治疗前HBV DNA含量比较,差异无统计学意义(P＞0.05).治疗12、24A8周后,观察组HBV DNA含量均明显低于对照组同时点[(3.5±0.9)lg拷贝/ml比(4.3±1.2)lg拷贝/ml、(3.3±0.7)lg拷贝/ml比(3.9±0.9)lg拷贝/ml、(3.0±0.5)lg拷贝/ml比(3.3±0.9)lg拷贝/ml],差异有统计学意义(P＜0.05).观察组治疗12、24、48周后的HBeAg转阴率和HBV DNA转阴率均高于对照组[21.2％(7/33)比12.5％ (4/32)、33.3％(11/33)比25.0％(8/32)、45.5％(15/33)比34.4％ (11/32);36.4％(12/33)比25.0％(8/32)、57.6％(19/33)比40.6％ (13/32)、78.8％(26/33)比62.5％ (20/32)],差异有统计学意义(P＜0.05).2组治疗前ALT、总胆红素、γ-GT、ALP、GLO水平比较,差异无统计学意义(P＞0.05).观察组治疗12、24、48周后ALT、总胆红素、γ-GT、ALP、GLO水平明显低于对照组同时点[(29 ±9)U/L比(34±12) U/L、(20 ±6)U/L比(30 ±8) U/L、(14 ±5)U/L比(22±7) U/L;(17 ±6) μmol/L比(30±8)μmol/L、(15±4) μmol/L比(23±6)μmol/L、(15 ±4) μmol/L比(20 ±6) μmol/L;(41±10)U/L比(65±13) U/L、(30 ±9) U/L比(54±11) U/L、(17 ±6) U/L比(26±8)U/L;(36 ±9) U/L比(60±12) U/L、(25±8)U/L比(37±10) U/L、(19±7)U/L比(27±9)U/L;(8.8±1.8)g/L比(15.5±2.1)g/L、(4.5±1.1)g/L比(10.5±1.9)g/L、(2.6±0.7)g/L比(7.8±1.4)g/L],差异有统计学意义(P＜0.05).观察组治疗12、24 、48周后的腹腔积液消失率均明显高于对照组[30.3％ (10/33)比15.6％(5/32)、45.5％(15/33)比25.0％(8/32)、75.8％(25/33)比53.1％(17/32)],差异有统计学意义(P＜0.05).2组治疗前慢性肝病问卷各项指标得分比较,差异无统计学意义(P＞0.05).观察组治疗24、48周后和对照组治疗48周后腹部症状、困乏、全身症状、活动能力、情感功能、焦虑得分均明显低于治疗前[观察组:(3.9±1.2)、(3.3±0.9)分比(4.8±1.5)分,(3.7±1.0)、(3.0±0.8)分比(4.3±1.3)分,(4.7±0.9)、(2.8±0.7)分比(5.7±1.0)分,(4.0±1.0)、(3.1±0.9)分比(4.7±1.3)分,(4.2±1.3)、(3.3±1.0)分比(4.7±1.6)分,(4.0±1.3)、(3.2±0.9)分比(4.3±1.6)分;对照组:(3.9±1.1)分比(4.4±1.5)分,(3.8±1.1)分比(4.2±1.3)分,(4.6±0.8)分比(5.7±0.9)分,(4.1±1.0)分比(4.4±1.3)分,(4.0±1.5)分比(4.5±1.8)分,(3.9±1.2)分比(4.4±1.5)分],治疗48周后,观察组各项指标得分明显低于对照组,差异均有统计学意义(均P＜0.05).结论 熊去氧胆酸联合阿德福韦酯能够有效抑制乙型肝炎肝硬化患者体内的HBV DNA含量,提高患者HBeAg转阴率,改善患者肝功能情况和生活质量.
    목적 탐토웅거양담산연합아덕복위지치료을형간염간경화적림상효과.방법 선취2010년10월지2014년12월재무한대학인민의원감염성질병과급황석시중심의원감염성질병과경간천자활검이급혈청검사학진적실대상기을형간염간경화환자65례,채용수궤수자표법분위관찰조(33례)화대조조(32례),관찰조환자구복아덕복위지효낭(10 mg/d,1차/d)화웅거양담산효낭(250 mg/편,2차/d)치료,대조조단순구복아덕복위지효낭(10 mg/d,1차/d)치료.2조기본료정위48주.비교2조치료전급치료12、24、48주후적을형간염병독(HBV) DNA함량、혈청병안산전안매(ALT)、총담홍소、γ곡안선전태매(γ-GT)、감성린산매(ALP)、혈청구단백(GLO)수평급만성간병문권득분정황(포괄복부증상、곤핍、전신증상、활동능력、정감공능、초필),화치료12、24、48주후적을형간염e항원(HBeAg)전음솔、HBV DNA전음솔급복강적액소실정황.결과 2조치료전HBV DNA함량비교,차이무통계학의의(P＞0.05).치료12、24A8주후,관찰조HBV DNA함량균명현저우대조조동시점[(3.5±0.9)lg고패/ml비(4.3±1.2)lg고패/ml、(3.3±0.7)lg고패/ml비(3.9±0.9)lg고패/ml、(3.0±0.5)lg고패/ml비(3.3±0.9)lg고패/ml],차이유통계학의의(P＜0.05).관찰조치료12、24、48주후적HBeAg전음솔화HBV DNA전음솔균고우대조조[21.2％(7/33)비12.5％ (4/32)、33.3％(11/33)비25.0％(8/32)、45.5％(15/33)비34.4％ (11/32);36.4％(12/33)비25.0％(8/32)、57.6％(19/33)비40.6％ (13/32)、78.8％(26/33)비62.5％ (20/32)],차이유통계학의의(P＜0.05).2조치료전ALT、총담홍소、γ-GT、ALP、GLO수평비교,차이무통계학의의(P＞0.05).관찰조치료12、24、48주후ALT、총담홍소、γ-GT、ALP、GLO수평명현저우대조조동시점[(29 ±9)U/L비(34±12) U/L、(20 ±6)U/L비(30 ±8) U/L、(14 ±5)U/L비(22±7) U/L;(17 ±6) μmol/L비(30±8)μmol/L、(15±4) μmol/L비(23±6)μmol/L、(15 ±4) μmol/L비(20 ±6) μmol/L;(41±10)U/L비(65±13) U/L、(30 ±9) U/L비(54±11) U/L、(17 ±6) U/L비(26±8)U/L;(36 ±9) U/L비(60±12) U/L、(25±8)U/L비(37±10) U/L、(19±7)U/L비(27±9)U/L;(8.8±1.8)g/L비(15.5±2.1)g/L、(4.5±1.1)g/L비(10.5±1.9)g/L、(2.6±0.7)g/L비(7.8±1.4)g/L],차이유통계학의의(P＜0.05).관찰조치료12、24 、48주후적복강적액소실솔균명현고우대조조[30.3％ (10/33)비15.6％(5/32)、45.5％(15/33)비25.0％(8/32)、75.8％(25/33)비53.1％(17/32)],차이유통계학의의(P＜0.05).2조치료전만성간병문권각항지표득분비교,차이무통계학의의(P＞0.05).관찰조치료24、48주후화대조조치료48주후복부증상、곤핍、전신증상、활동능력、정감공능、초필득분균명현저우치료전[관찰조:(3.9±1.2)、(3.3±0.9)분비(4.8±1.5)분,(3.7±1.0)、(3.0±0.8)분비(4.3±1.3)분,(4.7±0.9)、(2.8±0.7)분비(5.7±1.0)분,(4.0±1.0)、(3.1±0.9)분비(4.7±1.3)분,(4.2±1.3)、(3.3±1.0)분비(4.7±1.6)분,(4.0±1.3)、(3.2±0.9)분비(4.3±1.6)분;대조조:(3.9±1.1)분비(4.4±1.5)분,(3.8±1.1)분비(4.2±1.3)분,(4.6±0.8)분비(5.7±0.9)분,(4.1±1.0)분비(4.4±1.3)분,(4.0±1.5)분비(4.5±1.8)분,(3.9±1.2)분비(4.4±1.5)분],치료48주후,관찰조각항지표득분명현저우대조조,차이균유통계학의의(균P＜0.05).결론 웅거양담산연합아덕복위지능구유효억제을형간염간경화환자체내적HBV DNA함량,제고환자HBeAg전음솔,개선환자간공능정황화생활질량.
    Objective To investgate the effect of ursodeoxycholi acid combined with adefovir dipivoxil in treating hepatitis B cirrhosis.Methods Sixty-five patients with hepatitis B cirrhosis in decompensated stage confirmed by needle biopsy and serological test from October 2012 to December 2014 were randomly divided into observation group (33 cases) given oral administration of adefovir dipivoxil (10 mg/d, 1 time/d) and ursodeoxycholi acid (250 mg/d, 2 times/d), and control group (32 cases) given adefovir dipivoxil (10 mg/d, 1 time/d);both groups were treated with comprehensive treatment and the treatment was lasted for 48 weeks.Before and 12, 24, 48 weeks after treatment, the hepatitis B virus (HBV) DNA level, alanine aminotransferase (ALT) , total bilirubin (TBIL),γ-glutamyl-transferase (γ-GT), alkaline phosphatase (ALP), globulin (GLO) were measured;the score of chronic liver disease questionnaire (CLDQ) (including abdominal symptoms, fatigue, systemic symptoms, activity ability, emotional function, anxious) were assessed;the negative conversion rates of HBV e antigen (HBeAg) and HBV DNA, the disappearance rate of ascites were observed.Results The HBV DNA level had no significant difference between groups before treatment (P ＞ 0.05).The HBV DNA levels in observation group 12,24 and 48 weeks after treatment were significantly lower than those in control group [(3.5 ± 0.9) lg copies/ml vs (4.3 ± 1.2) lg copies/ml, (3.3 ± 0.7) lg copies/ml vs (3.9 ± 0.9) lg copies/ml, (3.0 ± 0.5) lg copies/ml vs (3.3 ± 0.9) lg copies/ml] (P ＜ 0.05).The negative conversion rates of HBeAg and HBV DNA in observation group 12, 24 and 48 weeks after treatment were significantly higher than those in control group [HBeAg: 21.2％ (7/33) vs12.5％ (4/32), 33.3％ (11/33)vs25.0％ (8/32),45.5％ (15/33)vs34.4％ (11/32);HBV DNA : 36.4％ (12/33) vs 25.0％ (8/32), 57.6％ (19/33) vs 40.6％ (13/32), 78.8％ (26/33) vs 62.5％ (20/32)] (P ＜ 0.05).The levels of ALT, TBIL, γ-GT, ALP, GLO had no significant differences between groups before treatment (P ＞ 0.05);they were significantly lower in observation group than those in control group after 12, 24 and 48 weeks after treatment [ALT: (29 ±9) U/L vs (34 ± 12) U/L, (20 ±6) U/L vs (30 ± 8) U/L, (14 ±5) U/L vs (22 ±7) U/L;TBIL: (17 ±6) μmol/L vs (30 ±8) μmol/L, (15 ±4) μmol/L vs (23 ±6) μmol/L, (15 ±4) μmol/L vs (20 ±6) μmol/L;γ-GT: (41 ± 10) U/L vs (65 ± 13) U/L, (30 ± 9) U/Lvs (54±11) U/L, (17±6) U/Lvs (26±8) U/L;ALP: (36±9) U/Lvs (60±12) U/L, (25±8) U/Lvs (37±10) U/L, (19±7) U/Lvs (27±9) U/L;GLO: (8.8±1.8) g/Lvs (15.5±2.1) g/L,(4.5 ± 1.1) g/L vs (10.5 ± 1.9) g/L, (2.6 ± 0.7) g/L vs (7.8 ± 1.4) g/L] (P ＜ 0.05).The disappearance rate of ascites in observation group was significantly higher than that in control group 12, 24 and 48 weeks after treatment [30.3％ (10/33)vs 15.6％ (5/32), 45.5％ (15/33)vs 25.0％ (8/32), 75.8％ (25/33)vs 53.1％ (17/32)] (P ＜ 0.05).The scores of CLDQ before treatment had no significant differences between groups (P ＞ 0.05);the scores of abdominal symptoms, fatigue, systemic symptoms, activity ability, emotional function, anxious 24 and 48 weeks after treatment were all significantly improved than those before treatment in observation [(3.9±1.2), (3.3±0.9) scores vs (4.8±1.5) scores;(3.7±1.0), (3.0±0.8) scores vs (4.3±1.3) scores;(4.7 ±0.9), (2.8 ±0.7) scores vs (5.7 ± 1.0) scores;(4.0± 1.0), (3.1 ± 0.9) scores vs (4.7 ± 1.3) scores;(4.2 ± 1.3) , (3.3 ± 1.0) scores vs (4.7 ± 1.6) scores;(4.0 ± 1.3) , (3.2±0.9) scores vs (4.3±1.6) scores] and control group [(3.9 ±1.1) scores vs (4.4±1.5) scores;(3.8±1.1) scoresvs (4.2±1.3) scores;(4.6±0.8) scores vs (5.7±0.9) scores;(4.1±1.0) scoresvs (4.4 ± 1.3) scores;(4.0 ± 1.5) scores vs (4.5 ± 1.8) scores;(3.9 ± 1.2) scores vs (4.4 ± 1.5) scores] (P ＜ 0.05);they were significantly lower in observation group than those in control group 48 weeks after treatment (P ＜ 0.05).Conclusion Ursodeoxycholi acid combined with adefovir dipivoxil can effectively inhibit the HBV DNA level, increase the negative converse rate of HBeAg and improve the life quality in patients with hepatitis B cirrhosis.
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