恩替卡韦治疗乙型肝炎肝硬化伴肝源性糖尿病患者疗效及其对糖代谢指标的影响

doi:10.3969/j.issn.1672-5069.2018.05.006

摘要/Abstract

摘要： 目的探讨恩替卡韦治疗乙型肝炎肝硬化并发肝源性糖尿病（HD）患者疗效及其对糖代谢指标的影响。方法采用随机数字表法将84例乙型肝炎肝硬化并发HD患者分为对照组42例和观察组42例,分别给予降糖、护肝等常规治疗或加用恩替卡韦抗病毒治疗,观察48 w。观察的糖代谢指标包括空腹血糖（FBG）、餐后2 h血糖（2h PBG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）和胰岛素抵抗指数（HOMA-IR）。采用放射免疫法测定血清肝纤维化指标,如层黏连蛋白（LN）、血清透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）。结果在治疗48 w末,观察组33例（78.6%）患者出现病毒学应答,对照组仅7例（16.7%）出现自发血清HBV DNA阴转,两组差异有统计学意义（P<0.05）;在治疗48 w末,观察组血清TBIL、ALT、ALB水平分别为（21.2±4.2） μmol/L、（43.3±12.7） IU/L和（39.4±1.8） g/L,与对照组的【（36.1±5.3） μmol/L、（77.1±15.2） IU/L和（33.9±3.4） g/L比,差异具有统计学意义（P<0.05）;FBG、2h PG、HbA1c、FINS和HOMA-IR水平分别为（5.3±0.7） mmol/L、（7.1±1.5） mmol/L、（6.1±0.6） %、（10.5±2.6） mU/L和（2.1±0.7）,显著低于对照组【（6.8±0.8） mmol/L、（10.3±1.6） mmol/L、（7.8±0.7） %、（15.6±4.0） mU/L和（3.1±0.6）,P<0.05】;血清LN、HA、PCⅢ、Ⅳ-C水平分别为（144.3±54.2） μg/L、（81.7±38.7） μg/L、（116.3±31.4） μg/L和（71.2±42.9） μg/L,显著低于对照组【（177.3±63.5） μg/L、（123.1±41.9） μg/L、（165.7±28.6） μg/L和（124.7±39.1） μg/L,P<0.01】。结论恩替卡韦治疗乙型肝炎肝硬化并发HD患者可抑制HBV复制,改善肝功能,稳定HD病情。

关键词: 肝硬化, 乙型肝炎, 肝源性糖尿病, 恩替卡韦, 胰岛素抵抗

Abstract: Objective To investigate the efficacy of entecavir in the treatment of patients with hepatitis B virus （HBV）-related cirrhosis complicated by hepatogenous diabetes （HD） and its influence on indexes of glucose metabolism. Methods 84 patients with HBV-related cirrhosis complicated by HD were divided into control （n=42） and observation group（n=42） by randomized number table generated by computer. The patients in control group were given antidiabetic,hepatoprotective and other conventional treatment,and at this basis,the patients in observation group were additionally treated with entecavir,and the observation was 48 weeks. After treatment,the virological response rates,serum liver function tests,glucose metabolism indexes and blood liver fibrosis indexes were compared between the two groups. Results The negative conversion rate of serum HBV DNA in the observation group at the end of 48 week treatment was higher than that in the control group （78.6% vs. 16.7%,P<0.05）;at the end 48 weeks,serum total bilirubin （TBIL）,alanine transaminase （ALT） and aspartate transaminase （AST） levels in the observation group were （21.2±4.2） μmol/L,（43.3±12.7） IU/L, （39.4±1.8） g/L, significantly different as compared to those in the control group [（36.1±5.3） μmol/L,（77.1±15.2） IU/L,（33.9±3.4）g/L,respectively,P<0.05];the fasting blood glucose （FBG）,2h postprandial blood glucose （2h PBG）,hemoglobin A1c （HbA1c）,fasting insulin （FINS）,insulin resistance index（HOMA-IR） in the observation group were （5.3±0.7） mmol/L,（7.1±1.5） mmol/L,（6.1±0.6） %,（10.5±2.6） mU/L and（2.1±0.7）,much lower than those in the control group [（6.8±0.8） mmol/L,（10.3±1.6） mmol/L,（7.8±0.7） %,（15.6±4.0） mU/L,（3.1±0.6）,P<0.05];serum laminin （LN）,serum hyaluronic acid （HA）,procollagen III （PC III） and type IV collagen （IV-C） levels in the observation group were （144.3±54.2） μg/L,（81.7±38.7） μg/L,（116.3±31.4） μg/L and（71.2±42.9） μg/L,also much lower than those in the control group [（177.3±63.5） μg/L,（123.1±41.9） μg/L,（165.7±28.6） μg/L and（124.7±39.1） μg/L,P<0.05]. Conclusion Entecavir can inhibit replication of HBV,improve liver function and stabilize HD in patients with HBV-related cirrhosis complicated by HD.

Key words: Cirrhosis, Hepatitis B, Hepatogenous diabetes, Entecavir, Insulin resistance

葛建祥, 孙晔子, 赵云. 恩替卡韦治疗乙型肝炎肝硬化伴肝源性糖尿病患者疗效及其对糖代谢指标的影响[J]. 实用肝脏病杂志, 2018, 21(5): 677-680.

Ge Jianxiang, Sun Yezi, Zhao Yun.. Application of entecavir in the treatment of patients with HBV-related cirrhosis complicated by hepatogenous diabetes and its influence on indexes of glucose metabolism[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 677-680.

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