拉米夫定联合阿德福韦酯治疗对失代偿期乙型肝炎肝硬化患者肝纤维化指标及血清炎性因子的影响

张慜鋆 金志恒 王健

【摘要】 目的：探讨拉米夫定联合阿德福韦酯对失代偿期乙型肝炎肝硬化患者肝纤维化指标及血清炎性因子的影响，分析其可能作用机制。方法：选择荆州市第二人民医院2016年1-12月收治的失代偿期乙型肝炎肝硬化患者128例为研究对象，根据入院单双号随机分为观察组和对照组，各64例。对照组给予阿德福韦酯治疗，观察组给予拉米夫定联合阿德福韦酯治疗，治疗1年后，比较两组肝脏纤维化、肝功能、炎性因子等指标。结果：观察组血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PCⅢ）含量均明显低于对照组（t=15.759、10.558、14.751，P<0.01）;血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBil）含量均明显低于对照组（t=13.957、14.833、20.983，P<0.01）;血清白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）含量均明显低于对照组（t=10.933、12.394、8.360，P<0.05）。结论：拉米夫定联合阿德福韦酯治疗有助于阻止失代偿期乙型肝炎肝硬化患者肝纤维化进展，改善肝功能，可能与降低血清炎性因子表达水平等因素有关。

【关键词】 失代偿期; 乙型肝炎肝硬化; 拉米夫定; 阿德福韦酯; 肝纤维化; 炎性因子

【Abstract】 Objective：To investigate the effect of the hepatic fibrosis index and serum inflammatory factors in patients with decompensated hepatitis B cirrhosis treated with Lamivudine and Adefovir Dipivoxil，both to analyze its possible mechanism.Method：128 patients with decompensated hepatitis B cirrhosis treated in the Second Peoples Hospital of Jingzhou were selected from January 2016 to December 2016.According to admission single-double numbers，patients were randomly divided into the observation group and the control group，64 cases in each group.In the control group，patients were treated with Adefovir Dipivoxil，in the observation group，patients were treated with Lamivudine plus Adefovir Dipivoxil.After one year of treatment，the indexes of liver fibrosis，liver function and inflammatory factors were compared between the two groups.Result：The levels of serum HA，LN and PCⅢ in the observation group were significantly lower than those in the control group（t=15.759，10.558，14.751，P<0.01）.Serum levels of ALT，AST and TBil in the observation group were significantly lower than those of the control group（t=13.957，14.833，20.983，P<0.01）.The contents of serum IL-6，hs-CRP and TNF-α in the observation group were significantly lower than those of the control group（t=10.933，12.394，8.360，P<0.05）.Conclusion：Lamivudine combined with Adefovir Dipivoxil treatment can help to prevent the progression of hepatic fibrosis in patients with decompensated hepatitis B cirrhosis and improve liver function，which may be related to factors such as reducing the expression level of serum inflammatory factors.

【Key words】 Decompensated; Hepatitis B cirrhosis; Lamivudine; Adefovir Dipivoxil; Index of liver fibrosis; Inflammatory cytokines

First-authors address：The Second Peoples Hospital of Jingzhou，Jingzhou 434000，China

doi：10.3969/j.issn.1674-4985.2019.05.006

失代償期乙型肝炎肝硬化是肝硬化晚期，5年生存率仅为14%[1]。除常规保肝、抗炎、抗纤维化治疗外，关键在于抗病毒治疗。拉米夫定能有效抑制乙型肝炎病毒（HBV）的复制，延缓乙型肝炎疾病进展，拉米夫定在慢性乙肝的疗效上已经有诸多报道[2-5]，但长期应用耐药发生率较高，易发生肝功能损害。阿德福韦酯是乙型肝炎病毒-脱氧核糖核酸（HBV-DNA）反转录酶抑制剂，可抑制拉米夫定耐药现象[6]。两者联合应用被各国指南推荐为失代偿期乙型肝炎肝硬化患者的首选治疗方案。相关研究表明，炎症反应在乙型肝炎肝硬化中发挥着重要的作用，其血清表达水平与肝硬化程度呈正相关[7]。拉米夫定联合阿德福酯治疗失代偿期乙型肝炎肝硬化文献报道很多，多从治疗有效性与安全性展开研究。……