抗病毒治疗对慢性乙型肝炎患者肝脏组织学的影响

摘要/Abstract

摘要： 目的分析慢性乙型肝炎患者的不同抗病毒治疗方式与疗程对肝组织学的影响,探讨临床用药的最佳方案。方法回顾性总结142例慢性乙型肝炎患者,分析其用药方式、疗程、肝脏生化学、病毒学、血清学、肝组织学等相关指标。结果病毒学完全应答:干扰素组58.93%(33/56),核苷(酸)类似物组90.20%(46/51),未抗病毒组0;HBeAg转阴率:干扰素组39.29%(22/56),核苷(酸)类似物组15.68%(7/51),未抗病毒组6%(2/35);HBsAg转阴率:干扰素组21.43%(12/56),核苷(酸)类似物组1.96%(1/51),未抗病毒组0;组织学应答:炎症改善方面,疗程≤1年者为干扰素组>核苷(酸)类似物组>未抗病毒组,疗程>1年者为核苷(酸)类似物组>干扰素组>未抗病毒组,而肝组织纤维化改善方面,不论疗程长短均为核苷(酸)类似物组>干扰素组>未抗病毒组。结论抗病毒治疗获得病毒学应答者肝脏组织学均能得到不同程度的改善;核苷(酸)类似物抗病毒治疗2年以上者肝组织学改善程度优于干扰素。

关键词: 乙型肝炎, 抗病毒治疗, 病毒学应答, 组织学改变

Abstract: Objective To investigate the effects of different antiviral therapies on liver histology in chronic hepatitis B (CHB) patients and discuss the best treatment regimen. Methods A total of 142 CHB patients were enrolled, and their drug history, treatment course, liver function, virology, serology, liver histology and other related prognosis factors were retrospectively analyzed. Results Complete virological response rate was 58.93% in interferon (IFN) group (33/56), 90.20% in nucleoside analogues (NAs) group (46/51) and 0 in non-antiviral group, respectively. HBeAg loss rate was 39.29% in IFN group (22/56), 15.68% in NAs group (7/51) and 6% in non-antiviral group (2/35), respectively. HBsAg loss rate was 21.43% in IFN group (12/56), 1.96% in NAs group (1/51) and 0 for non-antiviral group, respectively. In terms of histological response, inflammation improvement within 1-year-course treatment was IFN group > NAs group > non-antiviral group, while for over 1-year-course treatment was NAs group > IFN group > non-antiviral group. However, fibrosis improvement from high to low extent was NAs group, IFN group and non-antiviral group regardless of the course of treatment. Conclusion Both IFN and NAs antiviral therapies could achieve significantly histological improvement, especially NAs treatment for more than 2 years.

Key words: Hepatitis B; Antiviral therapy; Response of virology;Histology changes

陈育霞, 李东良. 抗病毒治疗对慢性乙型肝炎患者肝脏组织学的影响[J]. 肝脏, 2016, 21(10): 823-826.

CHEN Yu-xia, LI Dong-liang. Effects of antiviral therapy on liver histology in patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2016, 21(10): 823-826.

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