恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗失代偿期乙型肝炎肝硬化临床疗效观察

目的 探讨恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗失代偿期乙型肝炎肝硬化患者的临床疗效。方法 2015年3月~2017年8月我院收治的120例失代偿期乙型肝炎肝硬化患者被随机分为对照组60例和观察组60例,分别给予恩替卡韦分散片或恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗,观察24 w。结果 在治疗12 w时,观察组血清TBIL为（16.3±4.2） μmol/L,显著低于对照组的（26.3±5.2） μmol/L（P<0.05）,观察组血清ALB为（32.5±4.2）g/L,显著高于对照组的（30.2±5.3） g/L（P<0.05）;在治疗24 w时,观察组血清ALB为（37.8±2.3） g/L,显著高于对照组的（34.4±4.2） g/L（P<0.05）;观察组血清LN和C- IV分别为（65.2±15.1）ng/ml和（85.5±8.5） ng/ml,显著低于对照组的【（75.3±10.3） ng/ml和（96.2±10.3） ng/ml,P<0.05】;观察组血清HBV DNA水平为（1.0±0.1） lg copies/ml,与对照组的（1.7±0.3） lg copies/ml比,无显著性差异（P>0.05）,血清HBV DNA转阴率为100.0%,与对照组的90.0%比,无显著性差异（P>0.05）;在治疗12 w和24 w,观察组发生自发性细菌性腹膜炎（SBP）5例（8.3%）和2例（3.3%）,显著低于对照组的10例（16.7%）和8例（13.3%,P<0.05）;在治疗24 w末,观察组死亡3例（5%）,而对照组死亡10例（16.7%,P<0.05）。结论 恩替卡韦联合双歧杆菌乳杆菌三联活菌治疗失代偿期乙型肝炎肝硬化患者能短期改善肝功能指标,降低血清肝纤维化指标水平,减少并发症的发生。

Clinical efficacy of entecavir combined with live bifidobacterium and lactobacillus tablets in the treatment of hepatitis B patients with decompensated liver cirrhosis

Objective To investigate the clinical efficacy of entecavir combined with live bifidobacterium and lactobacillus tablets in the treatment of B patients with decompensated liver cirrhosis. Methods 120 patients with hepatitis B induced decompensated liver cirrhosis in the Affiliated Hospital of the Southwest Medical University between Jan. 2015 and Aug. 2017 were randomly divided into control and observation groups. The patients in the control group were administrated entecavir and patients in the observation group were administrated entecavir and live bifidobacterium and lactobacillus tablets. The index of liver function,hepatic fibrosis,HBV DNA and the rate of spontaneous bacterial peritonitis were compared between the two groups. Results At the end of 12 weeks,serum levels of ALT and TBIL in combination treatment group were（70.2±6.2） U/L and（16.3±4.2） μmol/L,both significantly lower than （76.2±9.6） U/L and （26.3±5.2） μmol/L in the control group（P<0.05）;serum level of ALB in the treatment group was （32.5±4.2） g/L,significantly higher than（30.2±5.3）g/L in the control group（P<0.05）;at the end of 24 weeks,serum levels of ALT and TBIL in the treatment group were （12.2±3.2） U/L and（6.2±1.3） μmol/L,both significantly lower than （26.4±3.2）U/L and （11.2±3.2） μmol/L in the control group （P<0.05）;serum level of ALB in the treatment group was （37.8±2.3） g/L,significantly higher than （34.4±4.2） g/L in the control group （P<0.05）;serum LN and C- IV were （65.2±15.1）ng/ml and （85.5±8.5）ng/ml,much lower than【（75.3±10.3）ng/ml and （96.2±10.3）ng/ml in the control,respectively,P<0.05】;serum HBV DNA level was （1.0±0.1）lg copies/ml,no significantly different as compared to （1.7±0.3） lg copies/ml in the control （P>0.05）,and serum HBV DNA negativity rate was 100.0%,also no significantly different as compared to 90.0% in the control（P>0.05）;at the end of 12 w and 24 w,the SBP occurred in 5（8.3%） and in 2（3.3%）,significantly lower than in 10（16.7%） and in 8（13.3% in the control （P<0.05）;at the end of 24 w,3（5%） died in the combination group,much lower than 10（16.7%） in the control（P<0.05）. Conclusion Entecavir combined with live bifidobacterium and lactobacillus tablets has a good clinical efficacy in treatment of hepatitis B patients with decompensated liver cirrhosis,which is worth further investigation.