恩替卡韦抗病毒治疗逆转慢性乙型肝炎肝纤维化和早期肝硬化的临床观察

摘要/Abstract

摘要： 目的观察恩替卡韦抗病毒治疗在逆转慢性乙型肝炎肝纤维化和早期肝硬化的临床应用。方法选取2020年2月至2022年2月慢性乙型肝炎患者80例,在满足川北医学院附属医院药学部用药规范的前提下分成观察组、对照组。观察组予以恩替卡韦治疗,对照组予以聚乙二醇干扰素α-2b注射液治疗。比较两组乙型肝炎病毒指标、肝功能指标、肝纤维化指标和临床疗效。结果观察组HBV DNA定量、HBsAg和HBeAg水平分别为(4.2±0.1)IU/mL、(848.6±115.6)U/mL和(181.3±70.0)U/mL,均显著低于对照组[(4.6±0.2)IU/mL、(939.1±125.2)U/mL和(222.2±82.3)U/mL,均P<0.05];治疗3个月后,观察组ALT、AST、Alb、TBil分别为(48.2±10.1)U/L、(45.6±15.6)U/L、(43.2±4.1)g/L、(18.3±3.0)μmol /L,显著低于对照组[(55.6±10.2)U/L、(56.1±15.2)U/L、(41.1±3.2)g/L、(20.2±4.1)μmol /L,均P<0.05];治疗后观察组透明质酸、Ⅲ型前胶原、层黏连蛋白、Ⅳ型胶原为(84.22±28.1)、(38.2±5.6)、(36.2±5.1)、(69.6±6.6),均显著低于对照组[(115.1±40.2)、(41.1±5.2)、(40.1±6.2)、(76.1±8.2),均P<0.05]。结论恩替卡韦抗病毒治疗在迅速恢复患者肝功能的同时,还可以进一步降低各项乙肝病毒指标以及肝纤维化指标,临床疗效确切。

关键词: 恩替卡韦, 逆转慢性乙型肝炎, 肝纤维化, 早期肝硬化

Abstract: Objective To observe the clinical application of entecavir antiviral therapy in reversing liver fibrosis and early cirrhosis in patients with chronic hepatitis B. Methods Eighty patients with chronic hepatitis B between February 2020 and February 2022 were selected in this study. They were divided into an observation group and a control group on the premise of meeting the drug use standard of the pharmacy department of the affiliated hospital of North Sichuan Medical College. Patients in the former group were given entecavir and those in the latter group were given pegylated interferon α-2b injection. The indexes of hepatitis B virus, liver function, liver fibrosis and clinical efficacy of the above groups were compared. Results In the observation group, the levels of deoxyribonucleic acid quantification of hepatitis B virus (HBV DNA), hepatitis B surface antigen (HBsAg), and hepatitis B virus e antigen (HBeAg) were (4.2 ± 0.1) IU/mL, (848.6 ± 115.6) U/mL, and (181.3 ± 70.0) U/mL respectively, all of which were significantly lower than those of [(4.6 ± 0.2) IU/mL, (939.1 ± 125.2) U/mL, and (222.2 ± 82.3) U/mL, P<0.05] in the control group. After 3 months of treatment, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), and total bilirubin (TBil) in the observation group were (48.2 ± 10.1) U/L, (45.6 ± 15.6) U/L, (43.2 ± 4.1) g/L, and (18.3 ± 3.0) μmol/L respectively, which were significantly lower than those of [(55.6 ± 10.2) U/L, (56.1 ± 15.2) U/L, (41.1 ± 3.2) g/L, and (20.2 ± 4.1) μmol/L, P<0.05] in the control group. After treatment, the levels of hyaluronic acid, type Ⅲ procollagen, laminin, and type Ⅳ collagen in the observation group were (84.22 ± 28.1), (38.2 ± 5.6), (36.2 ± 5.1), and (69.6 ± 6.6) respectively, all of which were significantly lower than those of [(115.1 ± 40.2), (41.1 ± 5.2), (40.1 ± 6.2), and (76.1 ± 8.2), P<0.05] in the control group. Conclusion Entecavir antiviral therapy can not only quickly restore liver function, but also further reduce the indicators of hepatitis B viral infection and liver fibrosis, with definite clinical effect.

Key words: Entecavir, Chronic hepatitis B, Liver fibrosis, Early cirrhosis, Reversal

李凌洁, 杨明, 吴伟平, 吴亚男, 黄永鹏. 恩替卡韦抗病毒治疗逆转慢性乙型肝炎肝纤维化和早期肝硬化的临床观察[J]. 肝脏, 2025, 30(9): 1215-1218.

LI Ling-jie, YANG Ming, WU Wei-ping, WU Ya-nan, HUANG Yong-peng. A clinical observation on the reversal of liver fibrosis and early cirrhosis in patients with chronic hepatitis B by entecavir antiviral therapy[J]. Chinese Hepatolgy, 2025, 30(9): 1215-1218.

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参考文献

[1] 吴文煜, 李维娜, 宁琴. 慢性乙型肝炎病毒感染自然史与不良临床结局[J]. 中国实用内科杂志,2020,40(6):446-450.
[2] Airewele N E, Shiffman M L. Chronic hepatitis B virus in patients with chronic hepatitis C virus[J]. Clin Liver Dis,2021,25(4):817-829.
[3] Sarowar A, Hirode G, Janssen H L A, et al. Controversies in treating chronic hepatitis B virus infection: discordant serologic results[J]. Clin Liver Dis,2021,25(4):805-816.
[4] 李力, 郭丽颖, 贾建伟, 等. 益气活血方联合恩替卡韦治疗慢性乙型肝炎肝纤维化临床研究[J]. 中西医结合肝病杂志,2019,29(3):217-220.
[5] Zhu W, Liu H, Zhang X. Toward curative immunomodulation strategies for chronic hepatitis B virus infection[J]. ACS Infect Dis,2019,5(5):703-712.
[6] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南[J]. 临床肝胆病杂志,2006,22(1):3-15.
[7] Huang Q, Zhou B, Cai D, et al. Rapid turnover of hepatitis B virus covalently closed circular dna indicated by monitoring emergence and reversion of signature-mutation in treated chronic hepatitis B patients[J]. Hepatology,2021,73(1):41-52.
[8] Jachs M, Sauberer R, Stiegler A, et al. Eligibility for antiviral therapy and treatment uptake in chronic hepatitis B patients referred to a european tertiary care center[J]. United European Gastroenterol J,2023,11(3):293-304.
[9] Kim S W, Yoon J S, Lee M, et al. Toward a complete cure for chronic hepatitis B: novel therapeutic targets for hepatitis B virus[J]. Clin Mol Hepatol,2022,28(1):17-30.
[10] 安选, 刘书宏, 夏莉娜, 等. HBeAg/HBeAb双阳性慢性乙型肝炎患者不同抗病毒方案疗效及临床转归分析[J]. 第三军医大学学报,2022,44(2):162-167.
[11] Choi W M, Choi J, Lim Y S. Effects of tenofovir vs entecavir on risk of hepatocellular carcinoma in patients with chronic HBV infection: a systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol,2021,19(2):246-258.
[12] 张敏, 李静, 王福生. 儿童慢性乙型肝炎抗病毒治疗与临床治愈:进展与挑战[J]. 中华肝脏病杂志,2021,29(12):1218-1223.
[13] 陈姝延, 孙亚朦, 周家玲, 等. 长期抗病毒治疗乙型肝炎肝硬化患者的组织学逆转率和临床改善情况[J]. 中华肝脏病杂志,2022,30(6):583-590.
[14] Lui G C Y, Wong N S, Wong R Y K, et al. Antiviral therapy for hepatitis B prevents liver injury in patients with tuberculosis and hepatitis B coinfection[J]. Clin Infect Dis,2020,70(4):660-666.
[15] 张梦阳, 孙亚朦, 尤红. 扩大慢性乙型肝炎抗病毒治疗:更多筛查,更多治疗[J]. 中华肝脏病杂志,2022,30(11):1133-1136.
[16] Hui R W, Mak L Y, Seto W K, et al. Chronic hepatitis B: a scoping review on the guidelines for stopping nucleos(t)ide analogue therapy[J]. Expert Rev Gastroenterol Hepatol,2023,17(5):443-450.
[17] 陈丽文, 祝达, 谢竟全, 等. 三种抗病毒治疗方案对ETV经治低病毒血症CHB患者HBV DNA转阴时间差异分析[J]. 海南医学,2021,32(6): 689-691.
[18] Bertolli M R, Rocha P A, Pinto V B, et al. Access to antiviral therapy for chronic hepatitis B during Covid-19[J]. Rev Assoc Med Bras (1992),2022,68(11):1509-1513.
[19] Lee H W, Yip T C, Tse Y K, et al. Hepatic decompensation in cirrhotic patients receiving antiviral therapy for chronic hepatitis B[J]. Clin Gastroenterol Hepatol,2021,19(9):1950-1958.
[20] 卢晶, 朴红心, 金雪梅, 等. 慢性乙型肝炎肝纤维化抗病毒治疗后生活质量与AST/PLT比率、肝硬度值、病理组织学的相关性分析[J]. 临床肝胆病杂志,2021,37(4):813-816.