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目的比较谷丙转氨酶(ALT)<2倍正常值上限(ULN)及ALT≥2倍ULN的慢性乙型肝炎(CHB)患者恩替卡韦抗病毒治疗的疗效。方法选择ALT<2倍ULN但肝脏炎症/纤维化≥G2/S2的CHB患者51例为观察组,同时选择符合ALT≥2倍ULN的CHB患者78例为对照组,所有患者随访开始抗病毒治疗后12、24、36、48周时的肝功能、HBV DNA、乙肝五项,并对观察组的部分患者再次复查肝脏炎症和纤维化程度。结果 48周治疗结束时,观察组与对照组E抗原阳性患者的ALT复常率(83.33%vs 97.44%),HBV DNA阴转率(96.15%vs 92.31%),E抗原阴转率(30.76%vs 41.03%),E抗原血清转换率(19.23%vs 35.89%)比较差异均无统计学意义(P>0.05)。观察组与对照组E抗原阴性患者的ALT复常率(90.91%vs100%),HBV DNA阴转率(100%vs 97.43%)差异均无统计学意义。比较观察组8例CHB患者抗病毒治疗前后的肝穿病理结果,5例患者抗病毒治疗后炎症或纤维化程度较前好转,其中1例患者抗病毒治疗后纤维化程度由S3转为S1。结论 ALT<2ULN但肝穿病理≥G2/S2的CHB患者初始给予ETV治疗同样具有良好的抗病毒治疗效果,积极的抗病毒治疗可以延缓和逆转肝纤维化进展。
Objective To compare the efficacy of antiviral therapy with entecavir in patients with chronic hepatitis B (CHB) who have ALT <2 times the upper limit of normal (ULN) and ALT ≥ 2 times ULN. Methods Totally 51 CHB patients with ALT <2 times ULN but with hepatic inflammation / fibrosis≥G2 / S2 were selected as the observation group and 78 CHB patients with ALT≥2 times ULN were selected as the control group. All patients were followed up for antiviral therapy After 12,24,36,48 weeks of liver function, HBV DNA, hepatitis B five, and some patients in the observation group again review the degree of liver inflammation and fibrosis. Results At the end of 48 weeks, the ALT normalization rate (83.33% vs 97.44%), HBV DNA negative rate (96.15% vs 92.31%), E antigen negative conversion rate (30.76% vs 41.03%). There was no significant difference in E antigen seroconversion rate (19.23% vs 35.89%) (P> 0.05). The ALT normalization rate (90.91% vs100%) and HBV DNA negative conversion rate (100% vs 97.43%) in the E antigen negative patients in the observation group and the control group were not significantly different. The pathological results of liver biopsy before and after antiviral therapy in 8 CHB patients in the observation group were compared. The degree of inflammation or fibrosis in the 5 patients was better than that in the antiviral treatment group. One patient had changed from S3 to S1 after antiviral treatment. Conclusion Initial treatment with ETV in CHB patients with ALT <2ULN but with pathological liver disease≥G2 / S2 also has a good antiviral effect. Active antiviral therapy can delay and reverse the progression of hepatic fibrosis.