复方鳖甲软肝片配合恩替卡韦治疗肝纤维化的声辐射力脉冲成像疗效评估

背景慢性乙型病毒性肝炎(chronic hepatitis B,CHB)患者长期受到慢性炎症刺激,容易发生肝纤维化.抗病毒配合中药治疗是目前治疗肝纤维化的主要手段.声辐射力脉冲成像(acoustic radiation force impulse,ARFI)能定量评估肝脏硬度状态,可为临床无创性评估抗纤维化疗效提供影像学手段.目的探讨ARFI评估恩替卡韦配合复方鳖甲软肝片治疗CHB肝纤维化的疗效.方法选取在我院诊治的92例CHB肝纤维化患者作为研究对象.所有患者均接受恩替卡韦配合复方鳖甲软肝片治疗,治疗前后行ARFI检查,测定肝组织ARFI值,同期测定血清肝纤维化指标、肝功能指标,并与肝穿刺活检结果进行比较.结果治疗后,患者肝功能指标丙氨酸转氨酶、天冬氨酸转氨酶较治疗前明显下降(P<0.05);治疗后,患者肝纤维化指标透明质酸、IV型胶原、层粘连蛋白较治疗前明显下降(P<0.05);治疗后,患者肝组织ARFI值较治疗前明显下降(P<0.05);治疗前后ARFI值均与肝纤维化病理分期呈正相关(r=0.82、0.84,P<0.05).结论ARFI能无创性准确反映恩替卡韦配合复方鳖甲软肝片治疗CHB肝纤维化前后的肝纤维化程度变化,可为临床疗效评估提供一种全新的影像学方法.

Therapeutic effect of entecavir combined with compound Biejia Ruangan tablets on liver fibrosis

BACKGROUND Chronic hepatitis B(CHB)patients often suffer from chronic inflammatory stimulation for a long time and are prone to liver fibrosis.Antiviral therapy combined with traditional Chinese medicine is the main treatment for liver fibrosis.Acoustic radiation force imaging(ARFI)can be used to quantitatively evaluate the hardness of the liver,thus providing an imaging means for clinical noninvasive evaluation of anti-fibrosis effect.AIM To evaluate the therapeutic effect of entecavir combined with compound Biejia Ruangan tablets on CHB liver fibrosis by ARFI.METHODS Ninety-two patients with CHB liver fibrosis were selected as study subjects.All patients were treated with entecavir combined with compound Biejia Ruangan tablets.ARFI was performed before and after treatment.Meanwhile,the indexes of serum liver fibrosis and liver function were measured before and after treatment.The results were compared with those of liver biopsy.RESULTS After treatment,serum alanine aminotransferase and aspartate aminotransferase,hyaluronic acid,type IV collagen,and laminin,and ARFI value decreased significantly(P<0.05).ARFI values were positively correlated with the stages of liver fibrosis before and after treatment(r=0.82,0.84,P<0.05).CONCLUSION ARFI can accurately reflect the change of CHB liver fibrosis degree before and after treatment of entecavir and compound Biejia Ruangan tablets,and provides a new imaging method for curative effect evaluation.