替诺福韦联合熊去氧胆酸对慢性乙型肝炎的疗效观察

李玉刚; 朱增红

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替诺福韦联合熊去氧胆酸对慢性乙型肝炎的疗效观察

临床医学 | 更新时间：2022-11-04

- 替诺福韦联合熊去氧胆酸对慢性乙型肝炎的疗效观察
- Efficacy of tenofovir combined with ursodeoxycholic acid in outpatient treatment of chronic hepatitis B
- 保健医学研究与实践 2022年19卷第4期页码：22-26
- 作者机构：
  
  焦作市第三人民医院感染科
- 作者简介：
- 基金信息：
- DOI：
  中图分类号： R512.62
- 纸质出版日期：2022，
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李玉刚, 朱增红. 替诺福韦联合熊去氧胆酸对慢性乙型肝炎的疗效观察[J]. 保健医学研究与实践, 2022,19(4):22-26.

Li Yugang, Zhu Zenghong. Efficacy of tenofovir combined with ursodeoxycholic acid in outpatient treatment of chronic hepatitis B[J]. Health Medicine Research and Practice, 2022,19(4):22-26.
李玉刚, 朱增红. 替诺福韦联合熊去氧胆酸对慢性乙型肝炎的疗效观察[J]. 保健医学研究与实践, 2022,19(4):22-26. DOI：

Li Yugang, Zhu Zenghong. Efficacy of tenofovir combined with ursodeoxycholic acid in outpatient treatment of chronic hepatitis B[J]. Health Medicine Research and Practice, 2022,19(4):22-26. DOI：

摘要

目的探究替诺福韦联合熊去氧胆酸对慢性乙型肝炎(CHB)的治疗效果。方法选取2017年1月20日—4月20日焦作市某医院收治的240例CHB患者[其中乙型肝炎e抗原(HBe Ag)阳性、阴性患者各120例]为研究对象

采用随机数字表法分为HBe Ag阳性实验组、HBe Ag阳性对照组和HBe Ag阴性实验组、HBe Ag阴性对照组

各60例。HBe Ag阳性对照组、HBe Ag阴性对照组患者给予替诺福韦治疗

HBe Ag阳性实验组、HBe Ag阴性实验组患者给予替诺福韦联合熊去氧胆酸治疗

4组患者均持续治疗48周

随访3年。比较4组患者乙肝病毒复制、肝损伤及不良反应发生情况

比较4组患者治疗前及随访3年时的肝功能[血清谷丙转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)]、肾功能[血肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白]、免疫功能[血清免疫球蛋白A(Ig A)、免疫球蛋白G(Ig G)]。结果治疗前

4组患者ALT、AST、GGT、TBIL水平比较

差异均无统计学意义(P>0.05)。随访3年时

HBe Ag阳性实验组和HBe Ag阳性对照组患者ALT、AST、GGT、TBIL水平低于治疗前

HBe Ag阳性实验组低于HBe Ag阳性对照组

差异均有统计学意义(P<0.05);随访3年时

HBe Ag阴性实验组和HBe Ag阴性对照组患者ALT、AST、GGT、TBIL水平低于治疗前

差异均有统计学意义(P<0.05)。治疗前

4组患者乙肝病毒的脱氧核糖核酸复制水平比较

差异均无统计学意义(P>0.05)。随访3年时

HBe Ag阳性实验组和HBe Ag阳性对照组患者乙肝病毒的脱氧核糖核酸复制水平低于治疗前

HBe Ag阳性实验组低于HBe Ag阳性对照组

差异均有统计学意义(P<0.05);随访3年时

HBe Ag阴性实验组和HBe Ag阴性对照组患者乙肝病毒的脱氧核糖核酸复制水平低于治疗前

差异均有统计学意义(P<0.05)。治疗前

4组患者Ig G、Ig A水平比较

差异均无统计学意义(P>0.05)。随访3年时

HBe Ag阳性实验组和HBe Ag阳性对照组患者Ig G、Ig A水平低于治疗前

HBe Ag阳性实验组低于HBe Ag阳性对照组

差异均有统计学意义(P<0.05);随访3年时

Hbe Ag阴性实验组和Hbe Ag阴性对照组患者Ig G、Ig A水平低于治疗前

差异均有统计学意义(P<0.05)。治疗前

4组患者24 h尿蛋白、SCr、BUN水平比较

差异均无统计学意义(P>0.05)。随访3年时

4组患者24 h尿蛋白、SCr、BUN水平高于治疗前

差异均有统计学意义(P<0.05)

但各组间比较

差异均无统计学意义(P>0.05)。HBe Ag阳性实验组患者肝损伤发生率为3.3%

低于HBe Ag阳性对照组的13.3%

差异有统计学意义(P<0.05);HBe Ag阴性实验组患者肝损伤发生率为1.7%

低于HBe Ag阴性对照组的15.0%

差异有统计学意义(P<0.05)。4组患者不良反应情况均无明显差异(P>0.05)。结论替诺福韦联合熊去氧胆酸治疗能显著改善CHB患者免疫功能和肝功能

降低病毒复制率和肝损伤发生率

且对HBe Ag阳性患者的治疗疗效优于HBe Ag阴性患者

值得在临床上推广使用。

Abstract

Objective To investigate the therapeutic effect of tenofovir combined with ursodeoxycholic acid on outpatient chronic hepatitis B（CHB）. Methods Two hundred and forty patients with CHB admitted to a hospital in Jiaozuo from January 20

2017 to April 20 [including 120 patients each with positive and negative hepatitis B eantigen（HBe Ag）] were selected for the study and divided into HBe Ag-positive experimental group

HBe Ag-n egative control group

HBe Ag-n egative experimental group

and HBe Ag-n egative control group

60 cases each. The patients in the HBe Ag-positive control group and HBe Ag-n egative control group were treated with tenofovir

and the patients in the HBe Ag-positive experimental group and HBe Ag-n egative experimental group were treated with tenofovir combined with ursodeoxycholic acid

and all four groups were treated for 48 weeks and followed up for 3 years. The incidence of hepatitis B virus replication

liver injury and adverse reactions in the four groups were compared

and the liver function [serum alanine transaminase（ALT）

aspartate aminotransferase（AST）

gamma-glutamyl transferase（GGT）

total bilirubin（TBIL）]

renal function [serum creatinine（SCr）

blood urea nitrogen（BUN）

24 h urine protein]

and immune function [serum immunoglobulin A（Ig A） and immunoglobulin G（Ig G）] were compared in the four groups before treatment and at 3 years of follow-up. Results Before treatment

there was no statistically significant difference in the levels of ALT

AST

GGT

and TBIL among the four groups（P>0.05）. At 3 years of follow-up

the levels of ALT

AST

GGT

and TBIL in patients in the HBe Ag-positive experimental group and HBe Ag-positive control group were lower than those before treatment

and those in the HBe Ag-positive experimental group were lower than those in the HBe Ag-positive control group

with statistically significant differences（P<0.05）; at 3 years of follow-up

patients in the HBe Ag-n egative experimental group and HBe Ag-n egative control group had lower ALT

AST

GGT

TBIL levels than those before treatment

and the differences were statistically significant（P<0.05）. Before treatment

the differences were not statistically significant when comparing the HBV-DNA levels of patients in the four groups（P>0.05）. At 3 years of follow-up

the HBV-DNA levels of patients in the HBe Ag-positive experimental group and HBe Ag-positive control group were lower than those before treatment

and those in the HBe Ag-positive experimental group were lower than those in the HBe Ag-positive control group

with statistically significant differences（P<0.05）; at 3 years of follow-up

the HBV-DNA levels of patients in the HBe Ag-n egative experimental group and the HBe Ag-n egative control group were lower than those before treatment

with statistically significant differences（P<0.05）. Before treatment

there was no statistically significant difference in the Ig G and Ig A levels among the four groups（P>0.05）. At 3 years of follow-up

the Ig G and Ig A levels of patients in the HBe Ag-positive experimental group and HBe Ag-positive control group were lower than before treatment

and those in the HBe Ag-positive experimental group were lower than those in the HBe Ag-positive control group

with statistically significant differences（P<0.05）; at 3 years of follow-up

the Ig G and Ig A levels of patients in the HBe Ag-n egative experimental group and HBe Ag-n egative control group were lower than before treatment

with statistically significant differences（P<0.05）. The differences were not statistically significant（P>0.05） when comparing the 24-h urine protein

SCr and BUN levels of the four groups before treatment. At 3 years of follow-up

the 24-h urine protein

SCr and BUN levels of patients in the 4 groups were higher than those before treatment

and the differences were statistically significant（P<0.05）

but the differences were not statistically significant（P>0.05） when compared between the groups. The incidence of liver injury in the HBe Ag-positive experimental group was 3.3%

which was lower than that in the HBe Ag-positive control group（13.3%）

and the difference was statistically significant（P<0.05）. The incidence of liver injury in the HBe Ag-n egative experimental group was 1.7%

which was lower than that of the HBe Ag-n egative control group（15.0%）

and the difference was statistically significant（P<0.05）. There was no significant difference in adverse reactions among the four groups（P>0.05）. Conclusion Tenofovir combined with ursodeoxycholic acid treatment can significantly improve the immune function and liver function of CHB patients

reduce the rate of viral replication and the incidence of adverse reactions

and the therapeutic efficacy on HBe Ag-positive patients is better than that on HBe Agnegative patients. The therapy is worth promoting in clinical practice.

关键词

替诺福韦熊去氧胆酸慢性乙型肝炎临床疗效

Keywords

TenofovirUrsodeoxycholic acidChronic hepatitis BClinical efficacy

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