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目的探讨抗病毒治疗对慢性重型乙型肝炎的抗纤维化疗效。方法收集慢性重型乙型肝炎病例,选取34例为治疗组,历史病例30例为对照组。治疗组在常规内科治疗的基础上加用抗病毒药物治疗(拉米夫定、恩替卡韦、替比夫定),对照组仅使用内科常规治疗。分析两组患者在不同时间点血清学肝纤维化指标检测及肝穿刺组织学活检结果。结果治疗组治疗前与治疗后3个月比较,层黏蛋白(LN)、Ⅲ型前胶原(PCⅢ)、透明质酸(HA)和Ⅳ胶原(ⅣC)差异均无统计学意义(P>0.05)。治疗后18个月,LN、PCⅢ、HA和ⅣC均明显下降,与治疗前比较,差异有统计学意义(P<0.05)。与治疗后3个月相比,治疗组18个月后52.9%(18/34)的患者肝组织学改善(治疗后HAI积分下降>2),其中47.0%(16/34)的患者坏死炎性反应程度改善(治疗后积分下降>2),35.3%(12/34)的患者纤维化程度改善(治疗后积分下降>1),差异均有统计学意义(P<0.05)。对照组患者治疗前后肝纤维化指标检测及肝穿刺组织学活检结果差异无统计学意义。结论抗病毒治疗能抑制慢性重型乙型肝炎患者的肝纤维化,使肝组织炎症明显好转,减少肝炎后肝硬化的发生率。
Objective To investigate the anti-fibrosis effect of antiviral therapy on chronic severe hepatitis B Methods Chronic severe hepatitis B cases were collected, 34 cases were selected as treatment group, 30 cases of history as control group. The treatment group was treated with antiviral drugs (lamivudine, entecavir, telbivudine) on the basis of conventional medical treatment, while the control group was treated with routine medical treatment. Analysis of two groups of patients at different time points serological markers of liver fibrosis and liver biopsy results. Results There were no significant differences in the levels of laminin (LN), PC Ⅲ, HA and ⅣC before treatment and 3 months after treatment in the treatment group (P> 0.05 ). At 18 months after treatment, the LN, PCⅢ, HA and Ⅳ C were significantly decreased compared with before treatment, the difference was statistically significant (P <0.05). Liver histology was improved in 52.9% (18/34) of patients at 18 months after treatment in the treatment group (a> 2 reduction in HAI scores after treatment) compared with 3 months after treatment, with 47.0% (16/34) of patients with necrotizing inflammation (P <0.05). The degree of sexual response was improved (after treatment, the scores decreased> 2), and the fibrosis degree was improved in 35.3% (12/34) patients (after treatment points decreased> 1). The control group patients before and after treatment of liver fibrosis index detection and liver biopsy histological differences were not statistically significant. Conclusion Antiviral therapy can inhibit liver fibrosis in patients with chronic severe hepatitis B, improve the inflammation of liver tissue and reduce the incidence of cirrhosis after hepatitis.