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目的探讨恩替卡韦与阿德福韦酯联合治疗对慢性乙型肝炎患者肝纤维化及血清谷丙转氨酶(ALT)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)水平的影响。方法选择本院94例慢性乙型肝炎患者,依据随机数字表法分为对照组和观察组,每组各47例。对照组予以阿德福韦酯治疗,观察组给予恩替卡韦+阿德福韦酯治疗,两组患者均持续治疗6个月,对比两组的临床疗效、不良反应,检测并对比两组治疗前后肝纤维化指标[Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸酶(HA)、甘胆酸(CG)]及血清ALT、TBIL、GGT水平变化情况。结果观察组治疗总有效率为87.23%(41/47)高于对照组的63.83%(30/47),差异有统计学意义(P<0.05)。两组治疗前肝纤维指标及血清ALT、TBIL、GGT水平比较,差异无统计学意义(P>0.05);治疗后观察组PCⅢ、LN、HA、CG及血清ALT、TBIL、GGT水平均低于对照组,差异有统计学意义(均P<0.05)。两组不良反应发生率对比(14.98%vs 8.51%),差异无统计学意义(P>0.05)。结论恩替卡韦与阿德福韦酯联合治疗慢性乙型肝炎可提高临床总有效率,有效改善患者肝纤维化及血清ALT、TBIL、GGT水平。
Objective To investigate the effects of entecavir and adefovir dipivoxil on hepatic fibrosis and serum levels of ALT, TBIL and GGT in patients with chronic hepatitis B (CHB). Methods Ninety-four patients with chronic hepatitis B in our hospital were divided into control group and observation group according to the random number table method, with 47 cases in each group. The control group was treated with adefovir dipivoxil, and the observation group was treated with entecavir plus adefovir dipivoxil. The patients in both groups were treated for 6 months continuously. The clinical efficacy and adverse reactions were compared between the two groups. (PC Ⅲ, LN, HA, CG), serum ALT, TBIL and GGT levels were measured. Results The total effective rate in the observation group was 87.23% (41/47), which was significantly higher than that in the control group (63.83%, 30/47). The difference was statistically significant (P <0.05). The liver fibrosis index, serum ALT, TBIL and GGT levels before treatment in both groups showed no significant difference (P> 0.05). After treatment, the levels of PCⅢ, LN, HA, CG, serum ALT, TBIL and GGT in the two groups were all lower than Control group, the difference was statistically significant (all P <0.05). There was no significant difference between the two groups in the incidence of adverse reactions (14.98% vs 8.51%) (P> 0.05). Conclusion The combination of entecavir and adefovir dipivoxil in the treatment of chronic hepatitis B can improve the total effective rate and improve the level of liver fibrosis, serum ALT, TBIL and GGT effectively.