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目的探讨恩替卡韦联合苦参素治疗HBeAg阳性慢性乙型肝炎(chronic hepatitis B,CHB)的临床疗效。方法将216例HBeAg阳性CHB患者随机分为治疗组和对照组。治疗组112例给予恩替卡韦联合苦参素治疗,对照组104例给予恩替卡韦治疗,疗程48周。治疗48周后,观察两组患者ALT水平、ALT复常率、HBV-DNA水平、HBV-DNA阴转率、HBeAg阴转率、HBeAg/HBeAb血清转换率及外周血T细胞亚群变化。结果治疗48周后,两组患者血清ALT水平均下降,ALT复常率分别为93.75%、87.50%,但两组间差异无统计学意义(P>0.05);两组患者血清HBV-DNA水平均下降,且治疗组血清HBV-DNA水平较对照组下降[(2.13±0.74)lg IU/mL vs.(3.98±1.61)lg IU/mL,P<0.01];治疗组HBV-DNA、HBeAg阴转率及HBeAg/HBe Ab血清转换率高于对照组(92.86%vs.83.65%,32.14%vs.19.23%,30.36%vs.18.27%,P均<0.05);治疗组CD4~+T细胞百分率及CD4~+T/CD8~+T比值上升,CD8~+T细胞百分率下降,与治疗前比较,差异有统计学意义[(26.76±6.32)%vs.(38.59±7.13)%,(0.93±0.32)vs.(1.70±0.36),(28.25±7.48)%vs.(22.47±5.91)%,P均<0.01];而对照组上述3项指标同治疗前比较,差异无统计学意义(P>0.05);治疗组CD4~+T细胞百分率及CD4~+T/CD8+T比例较对照组升高[(38.59±7.13)%vs.(27.41±6.57)%,(1.70±0.36)vs.(1.02±0.28),P均<0.01],而治疗组CD8~+T细胞百分率较对照组下降[(22.47±5.91)%vs.(26.33±5.76)%,P<0.01]。结论恩替卡韦与苦参素联合使用能有效增强抗HBV作用,同时能显著改善HBeAg阳性CHB患者外周血T淋巴细胞亚群状态。
Objective To investigate the clinical efficacy of entecavir combined with oxymatrine in the treatment of HBeAg-positive chronic hepatitis B (CHB). Methods 216 cases of HBeAg positive CHB patients were randomly divided into treatment group and control group. Treatment group, 112 cases of entecavir combined with kushenin treatment, control group, 104 cases of entecavir treatment, treatment of 48 weeks. After 48 weeks of treatment, ALT level, ALT normalization rate, HBV DNA level, HBV DNA negative rate, HBeAg negative conversion rate, HBeAg / HBeAb seroconversion rate and peripheral blood T cell subsets were observed. Results After treatment for 48 weeks, serum ALT levels decreased and the rates of ALT abnormalities were 93.75% and 87.50%, respectively, but there was no significant difference between the two groups (P> 0.05). Serum HBV-DNA levels (2.13 ± 0.74) lg IU / mL vs. (3.98 ± 1.61) lg IU / mL, respectively, P <0.01]. The levels of HBV DNA and HBeAg in the treatment group were significantly lower than those in the control group (P <0.05). The percentage of CD4 ~ + T cells in treatment group was higher than that in control group (92.86% vs.83.65%, 32.14% vs.19.23%, 30.36% vs.18.27%, P <0.05) (26.76 ± 6.32)% vs (38.59 ± 7.13)%, (0.93 ± 0.33)% respectively, and the percentage of CD4 ~ + T / CD8 ~ + T increased and the percentage of CD8 ~ + T cells decreased (P <0.32) vs. (1.70 ± 0.36), (28.25 ± 7.48)% vs (22.47 ± 5.91)%, P <0.01 respectively. There was no significant difference in the above three indexes between the two groups > 0.05). The percentage of CD4 ~ + T cells and CD4 ~ + T / CD8 + T in the treatment group were significantly higher than those in the control group [(38.59 ± 7.13)% vs (27.41 ± 6.57)%, (1.70 ± 0.36) vs (P <0.01). The percentage of CD8 + T cells in treatment group was significantly lower than that in control group [(22.47 ± 5.91)% vs (26.33 ± 5.76)%, P <0.01] Conclusion The combination of entecavir and oxymatrine can effectively enhance the anti-HBV effect and significantly improve the status of T lymphocyte subsets in peripheral blood of patients with HBeAg-positive CHB.