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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

20卷

期数:

2014年03期

页码:

204-208

栏目:

临床医学

出版日期:

2014-05-20

文章信息/Info

Title:

Comparison of entecavir efficacy in initial treatment for HBV patients with compensated and decompensated cirrhosis in 96 weeks

文章编号:

1006-8147(2014)03-0204-05

作者:

杨晓玲¹; 2; 李 嘉²; 周莉²; 王婧涵¹; 2; 刘均娟²; 高 敏²

(1.天津医科大学研究生院,天津 300070;2.天津市第二人民医院,天津市肝病医学研究所,天津 300192)

Author(s):

YANG Xiao-ling¹; 2;  LI Jia²; ZHOU Li²; WANG Jing-han¹; 2; LIU Jun-juan²; GAO Min²

(1.Graduate School, Tianjin Medical University,Tianjin 300070,China;2.Tianjin Second People’s Hospital, Tianjin Liver Disease Institute, Tianjin 300192, China)

关键词:

乙肝肝硬化; 代偿期; 失代偿期; 恩替卡韦; 疗效

Keywords:

hepatitis B cirrhosis;  compensated;  hepatitis B cirrhosis;  decompensated;  entecavir;  efficacy

分类号:

-

DOI:

-

文献标志码:

A

摘要:

目的：比较代偿期和失代偿期乙肝肝硬化患者接受恩替卡韦（ETV）初始抗病毒治疗疗效。方法：回顾性分析初始应用ETV治疗96周的代偿期（n=54）和失代偿期（n=51）肝硬化患者，比较两组治疗前后不同时间点肝功能、HBV DNA阴转率、Child-Puge评分、食管静脉曲张程度、肝硬度的变化和区别及临床结局的情况。结果：代偿期组12周和24周时血清丙氨酸转氨酶（ALT）复常率明显高于失代偿期组（P<0.01），12周HBV DNA阴转率明显高于失代偿期组（P<0.05）。代偿期和失代偿期组血清白蛋白分别于12周、24周开始明显高于基线（P<0.01），胆碱酯酶（CHE）分别于24周、48周开始明显高于基线（P<0.01）。96周时，100%代偿期和96.1%失代偿期组Child-Pugh评分表现为改善和稳定；11例代偿期和4例失代偿期患者食管静脉曲张有不同程度减轻；两组患者肝硬度均减低，代偿期组减低更明显，治疗后与基线比较差异有统计学意义（P<0.01)。结论：经长期ETV抗病毒治疗，代偿期肝硬化患者可获得更显著的疗效 。

Abstract:

Objective: To compare the efficacy of entecavir in initial treatment for HBV patients with compensated and decompensated cirrhosis in 96 weeks Methods: Data of 54 compensated and 51 decompensated cirrhotic patients treated with ETV(>96 weeks) were collected, and the difference of liver function, HBV DNA negativity, Child–Puge score, the degree of esophageal varix and liver stiffness value were compared before and after treatment between the groups. Results: Alanine aminotransferase normalized rate was significantly higher at 12 and 24 wk(P<0.01) and HBV DNA negativity rate was higher at 12 wk(P<0.05) in the compensated group than in the decompensated group. In the two groups, serum albumin levels were much higher than the baseline at 12 and 24 wk, respectively (P<0.01), and serum cholinesterase levels were significantly higher than the baseline at 24 and 48 wk, respectively (P<0.01). The Child–Pugh score improved or remained steady in all compensated patients and 96.1% of decompensated patients. The degree of esophageal varix was lessened including for 11 compensated and 4 decompensated patients. Liver stiffness value was significantly decreased in the compensated group compared with the baseline (P<0.01). Conclusion: Long-term ETV treatment has superior effect on the compensated cirrhotic patients.

参考文献/References:

[1] Jongh F E,Janssen H L,de Man R A,et al.Survival and prognostic indicators in hepatitis B surface antigen-positive cirrhosis of the liver[J].Gastroenterology,1992,103(5):1630
[2] Shim J H,Lee H C,Kim K M,et al.Efficacy of entecavir in treatment-naive patients with hepatitis B virus-related decompensated cirrhosis[J].J Hepatol,2010,52(2): 176
[3] Liaw Y F,Raptopoulou-Gigi M,Cheinquer H,et al.Efficacy and safety of entecavir versus adefovir in chronic hepatitis B patients with hepatic decompensation: a randomized, open-label study[J]. Hepatology,2011,54(1): 91
[4] Köklü S,Tuna Y,Gülsen M T,et al.Long-term Efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus–related cirrhosis[J].Clin Gastroenterol Hepatol,2013,11(1):88
[5] 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志，2000，8（6）:324
[6] 中华医学会肝病学分会、感染病学分会.慢性乙型肝炎防治指南[J].中华肝脏病杂志，2005，13(12):881
[7] Forman L M,Lucey M R.Predicting the prognosis of chronic liver disease: an evolution from the Child to MELD.Mayo End-stage Liver Disease[J].Hepatology,2001,33(2):473 [8] 中华医学会消化病学分会、中华医学会肝病学分会、中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治共识[J].中华消化杂志，2008，28（8）:551
[9] 梁静，韩涛，肖时湘，等.替比夫定治疗乙型肝炎肝硬化的疗效观察[J].中华肝脏病杂志，2009，17(1):24
[10] Liaw Y F,Sheen I S,Lee C M,et al.Tenofovir disoproxil fumarate (TDF), emtricitabine/TDF, and entecavir in patients with decompensated chronic hepatitis B liver disease[J].Hepatology,2011,53(1):62
[11] Manolakopoulos S,Triantos C,Theodoropoulos J,et al.Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension[J].J Hepatol,2009,51(3):468
[12] Liaw Y F. Reversal of cirrhosis: An achievable goal of hepatitis B antiviral therapy[J].J Hepatol,2013,59(4):880
[13] Marcellin P,Gane E,Buti M,et al.Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study[J].Lancet,2013,381(9865):468
[14] Osakabe K,Ichino N,Nishikawa T,et al.Reduction of liver stiffness by antiviral therapy in chronic hepatitis B[J].J Gastroenterol,2011,46(11):1324
[15] Enomoto M,Mori M,Ogawa T,et al.Usefulness of transient elastography for assessment of liver fibrosis in chronic hepatitis B: regression of liver stiffness during entecavir therapy[J].Hepatol Res,2010,40(9):853

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备注/Memo

备注/Memo:

 作者简介 杨晓玲（1986-），女，硕士在读，研究方向：内科产染病学（肝病方向）；通信作者：李嘉，E-mail: lijiadoctor1968@gmail.com。

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更新日期/Last Update: 2014-05-12