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目的探讨拉米夫定联合胸腺五肽治疗乙肝相关性肾炎(hepatitis B virus associated glomerulone nephritis,HBV-GN)的临床疗效。方法选择2009年01月—2013年12月收治的48例HBV-GN患者作为研究对象。随机分为对照组23例及观察组25例。对照组给予拉米夫定治疗,观察组在对照组的基础上给予胸腺五肽治疗,两组疗程均为6个月。观察两组临床疗效、24 h尿蛋白定量、血清白蛋白(albumin,ALB)、血肌酐(serum creatinine,Scr)、乙肝病毒标志物及HBV DNA等情况。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组总有效率为76.0%,明显高于对照组的47.8%,差异有统计学意义(P<0.05)。观察组HBe Ag转阴14例,占56.0%;对照组6例,占26.1%,差异有统计学意义(P<0.05)。观察组抗HBe转阳16例,占64.0%,对照组5例,占21.7%,差异有统计学意义(P<0.05)。治疗后,观察组ALB、Scr、24 h尿蛋白定量分别为(36.75±0.73)g/L、(81.25±4.28)μmol/L、(0.49±0.15)g,较对照组的(31.28±0.91)g/L、(84.62±3.64)μmol/L、(1.26±0.46)g,差异均有统计学意义(均P<0.05)。结论胸腺五肽联合拉米夫定治疗HBV-GN,可显著降低蛋白尿、升高血清白蛋白、保护肝肾功能。
Objective To investigate the clinical efficacy of lamivudine combined with thymopentin in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN). Methods 48 cases of HBV-GN patients admitted from January 2009 to December 2013 were selected as the study subjects. Randomly divided into control group 23 cases and observation group 25 cases. The control group was treated with lamivudine, and the observation group was treated with thymopentin on the basis of the control group. Both courses of treatment were 6 months. The clinical curative effect, 24 h urine protein quantitation, albumin (ALB), serum creatinine (Scr), HBV markers and HBV DNA were observed. Measurement data were compared between groups using t test, the group was compared using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The total effective rate in observation group was 76.0%, which was significantly higher than that in control group (47.8%), the difference was statistically significant (P <0.05). In the observation group, 14 cases (56.0%) had HBe Ag metastasized, while 6 cases (26.1%) had control group, the difference was statistically significant (P <0.05). In the observation group, 16 cases were positive for anti-HBe, accounting for 64.0%, and 5 cases in the control group, accounting for 21.7%. The difference was statistically significant (P <0.05). After treatment, the proteinuria of ALB, Scr and 24 h in the observation group were (36.75 ± 0.73) g / L, (81.25 ± 4.28) μmol / L and (0.49 ± 0.15) g respectively, which were significantly higher than those in the control group (31.28 ± 0.91) g / L, (84.62 ± 3.64) μmol / L and (1.26 ± 0.46) g, respectively, all with statistical significance (all P <0.05). Conclusion Thymopentin combined with lamivudine treatment of HBV-GN, can significantly reduce proteinuria, raise serum albumin, protect liver and kidney function.