2种用药方案治疗拉米夫定耐药慢性乙型肝炎的疗效及对血清层黏连蛋白、Ⅳ型胶原、Ⅲ型前胶原的影响

Efficacy of two drug regimens in treatment of lamivudine-resistant chronic hepatitis B and their influencs on serum laminin, type Ⅳ collagen and type Ⅲ procollagen

  • 摘要:
    目的 探讨2种用药方案对拉米夫定耐药慢性乙型肝炎的治疗效果。
    方法 选取2016年9月—2021年6月收治的150例拉米夫定耐药慢性乙型肝炎患者为研究对象,随机分为观察组和对照组,每组75例。对照组给予阿德福韦酯联合恩替卡韦治疗,观察组给予替诺福韦酯单药治疗。比较2组乙型肝炎病毒脱氧核糖核酸(HBV-DNA)转阴率; 观察2组治疗前后肝功能指标、肝纤维化指标变化以及不良反应发生情况。
    结果 观察组治疗12、24、48周后HBV-DNA转阴率分别为61.33%、78.67%、93.33%, 高于对照组的36.00%、57.33%、77.33%, 差异有统计学意义(P < 0.05)。治疗48周后, 2组血清天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)水平以及血清层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P < 0.05)。观察组不良反应发生率为17.33%, 对照组不良反应发生率为21.33%, 2组差异无统计学意义(P>0.05)。
    结论 相较于阿德福韦酯联合恩替卡韦,替诺福韦酯单药治疗拉米夫定耐药慢性乙型肝炎患者的效果更优,可显著改善患者肝功能、肝纤维化指标,且安全性良好,临床价值较高。

     

    Abstract:
    Objective To investigate the therapeutic effect of two drug regimens on lamivudine-resistant chronic hepatitis B.
    Methods A total of 150 patients with lamivudine-resistant chronic hepatitis B admitted from September 2016 to June 2021 were selected as research objects and randomly divided into observation group and control group, with 75 cases in each group. The control group was treated with adefovir dipivoxil combined with entecavir, while the observation group was treated with tenofovir disoproxil fumarate monotherapy. The negative conversion rate of hepatitis B virus deoxyribonucleic acid (HBV-DNA) was compared between the two groups; the changes of liver function indexes and liver fibrosis indexes before and after treatment as well as the occurrence of adverse reactions were observed in the two groups.
    Results After 12, 24 and 48 weeks of treatment, the HBV-DNA negative conversion rates of the observation group were 61.33%, 78.67% and 93.33%, respectively, which were significantly higher than 36.00%, 57.33% and 77.33% of the control group (P < 0.05). After 48 weeks of treatment, the levels of serum aspartate aminotransferase (AST), total bilirubin (TBIL) and alanine aminotransferase (ALT) as well as serum laminin (LN), type Ⅳ collagen (Ⅳ-C) and type Ⅲprocollagen (PCⅢ) levels in the two groups were significantly lower than those before treatment, and were significantly lower in the observation group than those of the control group(P < 0.05).The incidence of adverse reactions was 17.33% in the observation group and 21.33% in the control group, and there was no significant difference between the two groups (P>0.05).
    Conclusion Compared with adefovir dipivoxil combined with entecavir, tenofovir disoproxil fumarate monotherapy is more effective in the treatment of lamivudine-resistant chronic hepatitis B patients, which can significantly improve their liver function and liver fibrosis indexes, and has good safety and high clinical value.

     

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