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复方甘草酸苷联合恩替卡韦治疗乙肝患者早期肝硬化的临床研究
作者:郑岳  杨丽敏  王晋升 
单位:秦皇岛市第三医院 肝病科, 河北 秦皇岛 066000
关键词:复方甘草酸苷 恩替卡韦 纤维化 早期肝硬化 慢性乙型肝炎 
分类号:R575.2;R512.62
出版年·卷·期(页码):2019·47·第三期(255-259)
摘要:

目的:探讨复方甘草酸苷联合恩替卡韦治疗慢性乙型肝炎(简称乙肝)早期肝硬化患者的临床疗效及机制。方法:将74例早期肝硬化患者随机分为对照组(n=36)和实验组(n=38),对照组给予恩替卡韦0.5 mg口服,1次·d-1治疗,实验组在对照组治疗基础上给予复方甘草酸苷片50.0 mg口服,3次·d-1治疗,疗程均为48周;比较两组患者临床疗效,检测两组患者治疗前后肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、前白蛋白(PA)、总胆红素(TBIL)、γ-谷氨酰转肽酶(γ-GT)含量及乙型肝炎病毒(HBV)转阴率;采用瞬时弹性扫描仪测定两组患者治疗前后肝弹性变化;放射免疫方法测定两组患者治疗前后血清Ⅲ型前胶原(PⅢP)、Ⅳ型胶原透明质酸(HA)、层连蛋白(LN)含量;酶联免疫夹心法检测入组患者治疗前后血清高尔基体蛋白73(GP73)、纤维结合蛋白(Fn)含量。结果:实验组患者HBV转阴率、总有效率均高于对照组(P<0.05);与治疗前相比,两组患者治疗后肝脏弹性明显改善(P<0.05),血清ALT、AST、γ-GT、TBIL、PⅢP、HA、LN、Fn及GP73含量下降,ALB、PA含量增加(P<0.05);治疗后与对照组相比,实验组肝脏弹性改善趋势更加明显(P<0.05);实验组患者血清ALT、AST、γ-GT、TBIL、PⅢP、HA、LN、Fn及GP73含量更低,ALB、PA含量更高(P<0.05)。结论:复方甘草酸苷联合恩替卡韦治疗早期肝硬化疗效确切,其机制与抗HBV和改善肝脏纤维化有关。

Objective:To investigate the clinical efficacy of compound glycyrrhizin combined with entecavir in the treatment of patients with early cirrhosis of chronic hepatitis B(referred to as early stage cirrhosis) and its mech anism. Methods:A total of 74 patients with early cirrhosis were randomly divided into the control group(n=36) and the experimental group(n=38). The control group was treated with entecavir, and the experimental group was treated with compound glycyrrhizin tablets every day on the basis of the control group. The course of treatment was 48 weeks. Liver function indicators such as alanine aminotransferase(ALT), aspartate aminotransferase(AST), albumin(ALB), prealbumin(PA), total bilirubin(TBIL), γ-glutamyl transpeptidase(γ-GT) content and HBV negative rate were measured before and after treatment in two groups. Fibroscan was used to measure the changes of liver elasticity. The levels of serum type Ⅲ procollagen(PⅢP), type Ⅳ collagen hyaluronic acid (HA) and laminin (LN) were measured by radioimmunoassay before and after treatment; And serum golgi protein 73(GP73) and fibronectin (Fn) were measured by ELISA. Results:The HBV negative rate and total effective rate in the experimental group were higher than those in the control group (P<0.05). Liver elasticity of the control group and the experimentaly group was significantly improved after treatment (P<0.05), while serum ALT, AST, γ-GT, TBIL, P Ⅲ P, HA, LN, Fn and GP73 contents was decreased, and the content of serum ALB and PA was increased (P<0.05). Compared with the control group, liver elasticity improvement trend was more obvious in the experimental group (P<0.05). The levels of serum ALT, AST, γ-GT, TBIL, PⅢP, HA, LN, Fn and GP73 in the experimental group were lower than those in the control group, and the content of ALB and PA was higher (P<0.05). Conclusion:Compound Glycyrrhizin Combined with entecavir is effective in the treatment of early cirrhosis, and its mechanism is related to anti-virus and improvement of liver fibrosis.

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