[1]王树俊,孙会潇,徐　侠,等.去甲斑蝥素片联合替诺福韦酯治疗失代偿期肝硬化疗效观察[J].新乡医学院学报,2021,38(5):458-462.[doi:10.7683/xxyxyxb.2021.05.013]
　WANG Shujun,SUN Huixiao,XU Xia,et al.Effect of norcantharidin tablets combined with tenofovir disoprox in the treatment of decompensated cirrhosis[J].Journal of Xinxiang Medical University,2021,38(5):458-462.[doi:10.7683/xxyxyxb.2021.05.013]
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去甲斑蝥素片联合替诺福韦酯治疗失代偿期肝硬化疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年5
页码:
458-462
栏目:
临床研究
出版日期:
2021-05-05

文章信息/Info

Title:
Effect of norcantharidin tablets combined with tenofovir disoprox in the treatment of decompensated cirrhosis
作者:
王树俊; 孙会潇; 徐　侠; 王　满
（郑州市第一人民医院消化内科，河南　郑州　450000）
Author(s):
WANG Shujun; SUN Huixiao; XU Xia; WANG Man
(Department of Digestive System，Zhengzhou First People′s Hospital，Zhengzhou 450000，Henan Province，China)
关键词:
肝硬化; 去甲斑蝥素; 替诺福韦酯; 乙型肝炎病毒; 壳多糖酶3样蛋白1; 可溶性P选择素
Keywords:
liver cirrhosisnorcantharidintenofovir disoproxhepatitis B viruschitinase-3-like protein 1soluble P-selectin
分类号:
R575.3
DOI:
10.7683/xxyxyxb.2021.05.013
文献标志码:
A
摘要:
目的　探讨去甲斑蝥素联合替诺福韦酯治疗失代偿期肝硬化的临床效果。方法　选择2018年1月至2019年6月郑州市第一人民医院收治的90例失代偿期肝硬化患者为研究对象，按照治疗方法将患者分为观察组和对照组，每组45例。对照组患者给予替诺福韦酯治疗6个月，观察组患者给予去甲斑蝥素和替诺福韦酯联合治疗6个月。对2组患者治疗前后血清总胆红素（TBIL）、白蛋白（ALB）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、Ⅲ型前胶原蛋白（PC-Ⅲ）、透明质酸（HA）、Ⅳ型胶原蛋白（COL-Ⅳ）和层粘连蛋白（LN）、白细胞介素-6（IL-6）、转化生长因子-β1（TGF-β1）、肿瘤坏死因子-α（TNF-α）、高敏C反应蛋白（hs-CRP）、壳多糖酶3样蛋白1（YKL-40）、可溶性P选择素（sP-selectin）水平进行比较；治疗期间观察患者不良反应发生情况，治疗6个月后评估患者临床疗效；治疗后随访6个月，统计2组患者乙型肝炎e抗原（HBeAg）转阴率、乙型肝炎表面抗原（HBsAg）转阴率和乙型肝炎病毒（HBV）DNA转阴率。结果　治疗前2组患者血清ALT、AST、TBIL、ALB水平比较差异无统计学意义（P＞0.05）；与治疗前比较，治疗后2组患者血清ALT、AST、TBIL水平降低，ALB水平升高（P＜0.05）；治疗后，观察组患者血清ALT、AST、TBIL水平低于对照组，ALB水平高于对照组（P＜0.05）。治疗前2组患者血清COL-Ⅳ、PC-Ⅲ、HA、LN、IL-6、TGF-β1、TNF-α、hs-CRP、YKL-40、sP-selectin水平比较差异无统计学意义（P＞0.05）；2组患者治疗后血清COL-Ⅳ、PC-Ⅲ、HA、LN、IL-6、TGF-β1、TNF-α、hs-CRP、YKL-40、sP-selectin水平显著低于治疗前（P＜0.05）；治疗后，观察组患者血清COL-Ⅳ、PC-Ⅲ、HA、LN、IL-6、TGF-β1、TNF-α、hs-CRP、YKL-40、sP-selectin水平显著低于对照组（P＜0.05）。治疗6个月后，观察组患者HBeAg、HBsAg和HBV DNA转阴率分别为46.67%（21/45）、53.33%（24/45）、68.89%（31/45），对照组患者HBeAg、HBsAg和HBV DNA转阴率分别为24.44%（11/45）、31.11%（14/45）、40.00%（18/45）；观察组患者HBeAg、HBsAg和HBV DNA转阴率均显著高于对照组（χ2=4.851、4.552、7.570，P＜0.05）。治疗6个月后，观察组和对照组患者总有效率分别为93.33%（42/45）、75.56%（34/45），观察组患者总有效率显著高于对照组（χ2=16.192，P＜0.05）。2组患者均未发生严重不良反应。结论　去甲斑蝥素和替诺福韦酯联合治疗可以有效抑制失代偿期肝硬化患者HBV复制和机体炎症反应，改善肝纤维化和肝功能。
Abstract:
Objective　To investigate the therapeutic effect of norcantharidin tablets combined with tenofovir disoprox in the treatment of decompensated cirrhosis.Methods　　A total of 90 patients with decompensated cirrhosis admitted to Zhengzhou First People′s Hospital from January 2018 to June 2019 were selected as the research subjects，and the patients were divided into observation group and control group according to the treatment method，with 45 cases in each group.The patients in the control group were treated with tenofovir disoprox for six months，and the patients in the observation group were treated with norcantharidin and tenofovir disoprox for six months.The levels of serum total bilirubin (TBIL)，albumin (ALB)，aspartate aminotransferase (AST)，alanine aminotransferase (ALT)，type III procollagen (PC-Ⅲ)，hyaluronic acid (HA)，type IV collagen (COL-Ⅳ)，laminin (LN)，interleukin-6 (IL-6) and transforming growth factor transforming growth factor-β1(TGF- β1)，tumor necrosis factor-α（TNF-α），high sensitivity C-reactive protein (hs-CRP)，chitosanase-3-like protein 1 (YKL-40) and soluble P-selectin (sP-selectin) were compared between the two groups before and after treatment.The adverse reactions of patients were observed during the treatment，and the clinical efficacy was evaluated after six months of treatment.The patients were followed up for six months after treatment，and the negative rate of hepatitis B e antigen (HBeAg)，hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA of patients in the two groups were statistically analyzed.Results　There was no significant difference in serum ALT，AST，TBIL and ALB levels between the two groups before treatment (P＞0.05).Compared with before treatment，the levels of serum ALT，AST and TBIL in the two groups decreased，while the level of serum ALB increased (P<0.05).After treatment，the levels of serum ALT，AST and TBIL in the observation group were lower than those in the control group，and the level of serum ALB in the observation group was higher than that in the control group (P<0.05).There was no significant difference in serum COL-Ⅳ，PC-Ⅲ，HA，LN，IL-6，TGF-β1，TNF-α，hs-CRP，YKL-40 and sP-selectin levels between the two groups before treatment (P＞0.05).The levels of serum COL-Ⅳ，PC-Ⅲ，HA，LN，IL-6，TGF-β1，TNF-α，hs-CRP，YKL-40 and sP-selectin after treatment were significantly lower than those before treatment in the two groups(P＜0.05).The levels of serum COL-Ⅳ，PC-Ⅲ，HA，LN，IL-6，TGF-β1，TNF-α，hs-CRP，YKL-40 and sP-selectin in the observation group were significantly lower than those in the control group after treatment (P＜0.05).After six months of treatment，the negative rates of HBeAg，HBsAg and HBV DNA in the observation group were 46.67%(21/45)，53.33%(24/45) and 68.89%(31/45)，respectively;while those in the control group were 24.44%(11/45)，31.11%(14/45) and 40.00%(18/45) ，respectively.The negative rates of HBeAg，HBsAg and HBV DNA in the observation group were significantly higher than those in the control group (χ2=4.851，4.552，7.570;P＜0.05).After six months of treatment，the total effective rate in the observation group and the control group was 93.33%(42/45) and 75.56%(34/45)，respectively.The total effective rate in the observation group was significantly higher than that in the control group (χ2=16.192，P＜0.05).No serious adverse reactions occurred in both groups.Conclusion　Norcantharidin combined with tenofovir disoprox can effectively inhibit HBV replication and inflammatory response，and improve liver fibrosis and liver function in patients with decompensated cirrhosis.

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更新日期/Last Update: 2021-05-05