[1]王 婷,邹百仓,董 蕾,等.核苷类似物治疗乙型肝炎肝硬化并发食管静脉曲张临床价值研究[J].陕西医学杂志,2024,(5):671-674.[doi:DOI:10.3969/j.issn.1000-7377.2024.05.021]
　WANG Ting,ZOU Baicang,DONG Lei,et al.Value of nucleoside analogues in the treatment of hepatitis B cirrhosis complicated with esophageal varices[J].,2024,(5):671-674.[doi:DOI:10.3969/j.issn.1000-7377.2024.05.021]
点击复制

核苷类似物治疗乙型肝炎肝硬化并发食管静脉曲张临床价值研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2024年5期
页码:
671-674
栏目:
药物与临床
出版日期:
2024-05-05

文章信息/Info

Title:
Value of nucleoside analogues in the treatment of hepatitis B cirrhosis complicated with esophageal varices
作者:
王 婷; 邹百仓; 董 蕾; 薛 琼; 王进海; 陈芬荣
(西安交通大学第二附属医院消化内科,陕西 西安 710004)
Author(s):
WANG Ting; ZOU Baicang; DONG Lei; XUE Qiong; WANG Jinhai; CHEN Fenrong
(Department of Gastroenterology,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)
关键词:
肝硬化;  乙型肝炎病毒;  食管静脉曲张;  核苷类似物;  消化道出血
Keywords:
Cirrhosis;  Hepatitis B virus;  Esophageal varices;  Nucleoside analogues;  Gastrointestinal bleeding
分类号:
R 657.31
DOI:
DOI:10.3969/j.issn.1000-7377.2024.05.021
文献标志码:
A
摘要:
目的:探讨核苷类似物治疗乙型肝炎肝硬化并发食管静脉曲张临床价值。方法:选取乙型肝炎肝硬化并发食管静脉曲张患者88例,根据是否抗病毒治疗分为对照组(33例)和治疗组(55例)。比较两组患者治疗前后肝功能指标[白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)]、Child-Pugh评分和凝血功能指标[凝血酶原时间(PT)、凝血酶原活动度(PTA)]以及治疗后乙型肝炎病毒DNA(HBV-DNA)阴转率、食管静脉曲张程度和消化道出血情况。结果:抗病毒治疗后,治疗组患者TBIL、ALT、AST较治疗前降低,ALB较治疗前升高(均P<0.05)。抗病毒治疗后,治疗组患者PT较治疗前降低,且治疗组低于对照组; 治疗组PTA较治疗前升高,且治疗组高于对照组(均P<0.05)。治疗组抗病毒治疗后Child-Pugh评分较治疗前降低,且治疗组Child-Pugh评分低于对照组(均P<0.05)。与对照组比较,治疗组在抗病毒治疗后HBV-DNA阴转率升高(P<0.05)。在未行EVL治疗患者中,治疗组食管静脉曲张减轻程度高于对照组(P<0.05)。在接受及未接受EVL治疗的患者中,治疗组消化道出血率低于对照组(均P<0.05)。结论:核苷类似物能够抑制乙型肝炎肝硬化并发食管静脉曲张患者HBV病毒复制,改善肝功能和凝血功能,减轻食管静脉曲张程度,降低消化道出血风险。
Abstract:
Objective:To investigate the clinical value of nucleoside analogues in the treatment of hepatitis B cirrhosis complicated with esophageal varices.Methods:Eighty-eight patients with hepatitis B cirrhosis complicated with esophageal varices were selected and divided into control group(33 cases)and treatment group(55 cases)according to whether antiviral treatment was given.Liver function indexs(albumin [ALB],alanine aminotransferase [ALT],aspartate aminotransferase [AST],total bilirubin [TBIL]),Child-Pugh score and coagulation function indexes(prothrombin time [PT],prothrombin activity [PTA])were compared between the two groups before and after treatment.The negative conversion rate of hepatitis B virus DNA(HBV-DNA),the degree of esophageal varices and gastrointestinal bleeding were compared between two groups after treatment.Results: After antiviral treatment,TBIL,ALT and AST in treatment group were lower than before treatment,and ALB was higher than before treatment(all P<0.05).After antiviral treatment,PT in the treatment group was lower than before treatment,and the treatment group was lower than the control group.PTA in the treatment group was higher than that before treatment,and the treatment group was higher than the control group(all P<0.05).After antiviral treatment,the Child-Pugh score of the treatment group was lower than that before treatment,and the Child-Pugh score of the treatment group was lower than that of the control group(all P<0.05).Compared with the control group,the negative conversion rate of HBV-DNA in the treatment group was increased after antiviral treatment(P<0.05).In patients who did not receive EVL treatment,the reduction degree of esophageal varices in the treatment group was higher than that in the control group(P<0.05).In patients who received EVL and those who did not receive EVL,the rate of gastrointestinal bleeding in the treatment group was lower than that in the control group(all P<0.05).Conclusion:Nucleoside analogues can inhibit HBV virus replication in patients with hepatitis B cirrhosis complicated with esophageal varices,improve liver function and coagulation function,reduce the degree of esophageal varices,and reduce the risk of gastrointestinal bleeding.

参考文献/References:

[1] 杨金艳,李飞飞,谢元元,等.肝硬化上消化道出血患者预后营养指数与病情严重程度和短期预后相关性研究[J].陕西医学杂志,2023,52(11):1530-1534.
[2] 戴二黑,郭心如,王继涛,等.肝硬化的病因及防治现状调查[J].中华医学杂志,2023,103(12):913-919.
[3] 王春妍,曹宇,冯永美,等.经NAs长期治疗后HBV DNA低于检测下限乙型肝炎肝硬化患者的HBV RNA水平分析及其意义[J].中华肝脏病杂志,2022,30(7):758-762.
[4] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2022年版)[J].中华传染病杂志,2023,41(1):3-28.
[5] TANG L S Y,COVERT E,WILSON E,et al.Chronic hepatitis B infection:A review[J].JAMA,2018,319(17):1802-1813.
[6] CHEN S,LI J,WANG D,et al.The hepatitis B epidemic in China should receive more attention[J].Lancet,2018,391(10130):1572.
[7] CUI F,SHEN L,LI L,et al.Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy,China[J].Emerg Infect Dis,2017,23(5):765-772.
[8] LE L V,BLACH S,REWARI B,et al.Progress towards achieving viral hepatitis B and C elimination in the Asia and Pacific region:Results from modelling and global reporting[J].Liver Int,2022,42(9):1930-1934.
[9] 高宏琴.核苷(酸)类抗病毒药物对失代偿期乙肝肝硬化患者肝脏指标及预后的改善效果[J].中国实用医刊,2016,43(23):39-41.
[10] 刘小莹,郑宏波,王山军,等.恩替卡韦单药方案维持对初始行拉米夫定+阿德福韦酯方案治疗慢性乙型肝炎及慢性乙型肝炎后肝硬化疗效影响[J].陕西医学杂志,2020,49(4):502-505.
[11] LI H,YAN L,SHI Y,et al.Hepatitis B virus infection:Overview[J].Adv Exp Med Biol,2020,1179:1-16.
[12] JUNG Y K,YIM H J.Reversal of liver cirrhosis:Current evidence and expectations[J].Korean J Intern Med,2017,32(2):213-228.
[13] CUI N,HU M,KHALIL R A.Biochemical and biological attributes of matrix metalloproteinases[J].Prog Mol Biol Transl Sci,2017,147:1-73.
[14] 王冰琼,吴晓宁,欧晓娟,等.长期抗病毒治疗逆转乙型肝炎肝纤维化和早期肝硬化[J].中国临床医生杂志,2022,50(10):1136-1138.
[15] LI Q,CHEN L,ZHOU Y.Changes of fibroscan,APRI,and FIB-4 in chronic hepatitis B patients with significant liver histological changes receiving 3-year entecavir therapy[J].Clin Exp Med,2018,18(2):273-282.
[16] 吴青青,尹乔乔,郑伟,等.慢性乙型肝炎相关肝硬化患者治疗后肝脏纤维化程度改变研究进展[J].国际流行病学传染病学杂志,2019,46(3):251-253.
[17] 朱艳萍,胡欣欣,袁灵,等.核苷(酸)类似物对乙型肝炎肝硬化患者食管静脉曲张的影响[J].重庆医学,2019,48(4):671-672,675.
[18] LI C Z,CHENG L F,LI Q S,et al.Antiviral therapy delays esophageal variceal bleeding in hepatitis B virus-related cirrhosis[J].World J Gastroenterol,2013,19(40):6849-6856.
[19] LAMPERTICO P,INVEMIZZ F,VIGANO M,et al.The long-term benefits of nucleos(t)ide analogs in compensated HBV cirrhotic patients with no or small esophageal varices:A 12-year prospective cohort study[J].J Hepatol,2015,63(5):1118-1125.
[20] 张会涛,尚丽,李秋雅,等.护肝利水汤联合特利加压素治疗肝硬化腹水临床疗效及对患者血清学指标与门静脉压力的影响[J].陕西中医,2020,41(5):593-596.
[21] ZHAO Y,REN M,LU G,et al.The prognosis analysis of liver cirrhosis with acute variceal bleeding and validation of current prognostic models: A large scale retrospective cohort study[J].Biomed Res Int,2020,2020:7372868.
[22] 汪保胜.恩替卡韦对不同时期乙肝肝硬化患者抗病毒的疗效评价[J].基层医学论坛,2017,21(13):1605-1607.
[23] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会消化内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].中华内科杂志,2023,62(1):7-22.
[24] 李瑶,刘力,谭福雄,等.鳖甲煎丸联合恩替卡韦治疗乙型肝炎肝硬化疗效Meta分析[J].陕西中医,2020,41(9):1329-1334.
[25] HE L,YE X,MA J,et al.Antiviral therapy reduces rebleeding rate in patients with hepatitis B-related cirrhosis with acute variceal bleeding after endotherapy[J].BMC Gastroenterol,2019,19(1):101.

相似文献/References:

[1]杨丽娟,郝小康,周 军.慢性乙型肝炎患者Toll样受体2与乙型肝炎病毒DNA表达水平相关性研究[J].陕西医学杂志,2021,50(6):697.[doi:DOI:10.3969/j.issn.1000-7377.2021.06.014]
　YANG Lijuan,HAO Xiaokang,ZHOU Jun.Correlation between HBV-DNA and TLR2 levels in patients with chronic hepatitis B[J].,2021,50(5):697.[doi:DOI:10.3969/j.issn.1000-7377.2021.06.014]
[2]王小芳,张利军.可溶性人髓系细胞触发受体1、可溶性血红蛋白清道夫受体、降钙素原表达水平对肝硬化合并自发性细菌性腹膜炎的诊断价值[J].陕西医学杂志,2021,50(12):1525.[doi:DOI:10.3969/j.issn.1000-7377.2021.12.014]
[3]郭武辉,张 华.血清T淋巴细胞亚群检测在肝硬化合并真菌性血流感染中的诊断价值[J].陕西医学杂志,2021,50(12):1570.[doi:DOI:10.3969/j.issn.1000-7377.2021.12.026]
　GUO Wuhui,ZHANG Hua.Diagnostic value of serum T lymphocyte subsets detection in liver cirrhosis complicated with fungal bloodstream infection[J].,2021,50(5):1570.[doi:DOI:10.3969/j.issn.1000-7377.2021.12.026]
[4]刘 娟,康星星.人类免疫缺陷病毒感染/获得性免疫缺陷综合征患者476例乙型、丙型肝炎病毒及梅毒螺旋体感染情况调查研究[J].陕西医学杂志,2021,50(12):1598.[doi:DOI:10.3969/j.issn.1000-7377.2021.12.033]
　LIU Juan,KANG Xingxing.Investigation on HBV,HCV and TP infection in 476 HIV/AIDS patients[J].,2021,50(5):1598.[doi:DOI:10.3969/j.issn.1000-7377.2021.12.033]
[5]樊江浩,王 嘉,万 杰,等.肝硬化门静脉血栓抗凝治疗有效性及安全性Meta分析[J].陕西医学杂志,2023,52(4):487.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.028]
　FAN Jianghao,WANG Jia,WAN Jie,et al.Efficacy and safety of anticoagulant therapy for portal vein thrombosis in liver cirrhosis:a meta-analysis[J].,2023,52(5):487.[doi:DOI:10.3969/j.issn.1000-7377.2023.04.028]
[6]刘 杰,闵林玲,潘 金,等.经颈静脉肝内门腔静脉分流术与经皮肝穿刺胃冠状静脉栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效对比研究[J].陕西医学杂志,2023,52(9):1191.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.017]
　LIU Jie,MIN Linling,PAN Jin,et al.Comparative study of TIPS and PTVE in treatment of esophageal and gastric varices bleeding in liver cirrhosis[J].,2023,52(5):1191.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.017]
[7]杨金艳,李飞飞,谢元元,等.肝硬化上消化道出血患者预后营养指数与病情严重程度和短期预后相关性研究[J].陕西医学杂志,2023,52(11):1530.[doi:DOI:10.3969/j.issn.1000-7377.2023.11.017]
[8]冯晓霞,陈玉仙,张晓萍.妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染与患者妊娠结局相关性研究[J].陕西医学杂志,2025,54(2):227.[doi:DOI:10.3969/j.issn.1000-7377.2025.02.017]

备注/Memo

备注/Memo:
基金项目:陕西省重点研发计划项目(2022SF-460)
更新日期/Last Update: 2024-05-06