恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.03.004

摘要/Abstract

摘要： 目的探讨恩替卡韦(ETV)联合多烯磷脂酰胆碱(PPC)治疗慢性乙型肝炎(CHB)合并非酒精性脂肪性肝炎(NASH)患者的疗效。方法 2021年5月～2023年6月我院收治的CHB合并非酒精性脂肪性肝病(NAFLD)患者94例,其中合并非酒精性脂肪肝(NAFL)患者61例(对照组),合并NASH患者33例(观察组),分别给予恩替卡韦(ETV)治疗或ETV联合PPC治疗,观察6个月。常规检测血生化、空腹血糖和胰岛素水平,计算胰岛素抵抗指数(HOMA-IR),采用ELISA法检测血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(ⅣC)和层黏蛋白(LN),使用Fibroscan行肝硬度检测(LSM)和受控衰减参数(CAP)。结果在治疗6个月末,观察组血清ALT和AST水平分别为(37.1±4.6)U/L和(34.5±3.8)U/L,显著低于治疗前【分别为(80.8±16.4)U/L和(62.7±12.8)U/L,P<0.05】,两组血清HBV DNA均转阴;两组血清TC、TG、LDL-C、HDL-C和HOMA-IR比较,无显著性差异(P>0.05);观察组血清PCⅢ和HA水平分别为(109.5±13.7)ng/mL和(101.3±12.7)ng/mL,显著低于对照组【分别为(136.4±17.1)ng/mL和(138.5±17.3)ng/mL,P<0.05】;观察组CAP值为(255.8±26.9)dB/m,显著低于对照组【(269.4±30.1)dB/m,P<0.05】。结论应用ETV联合PPC治疗CHB合并NASH患者可显著促进肝功能指标恢复,降低肝纤维化指标,改善肝脂肪变,值得深入研究。

关键词: 慢性乙型肝炎, 非酒精性脂肪性肝炎, 恩替卡韦, 多烯磷脂酰胆碱, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of combination of entecavir and polyene phosphatidylcholine (PPC) therapy in the treatment of patients with chronic hepatitit B (CHB) and nonalcoholic steatohepatitis (NASH). Methods 94 patients with CHB and non-alcoholic fatty liver disease (NAFLD) were recruited in our hospital between May 2021 and June 2023, including nonalcoholic fatter liver (NAFL) in 61 cases and NASH in 33 cases. All patients received enticavir (ETV) for antiviral treatment, and the patients with CHB and concomitant NASH received ETV and PPC combination therapy. The regimen lasted for six months. The routine serum detection was carried out for HOMA-IR calculation. Serum hyaluronic acid (HA), procollagen type III (PCIII), collagen type IV (IVC) and laminin (LN) levels were detected by ELISA. The Liver stiffness measurement (LSM) and controlled attenuation parameters (CAP) were detected by Fibroscan. Results At the end of six-month observation, serum ALT and AST levels in patients with CHB and NASH were (37.1±4.6)U/L and (34.5±3.8)U/L, both significantly lower than [(80.8±16.4)U/L and (62.7±12.8)U/L, respectively, P<0.05] at admission, and serum HBV DNA in all patients in the two groups became negative; there were no significant changes about the serum fat parameters and HOMA-IR (P>0.05) in the two groups; serum PCⅢ and HA levels in CHB patients with NASH were (109.5±13.7)ng/mL and (101.3±12.7)ng/mL, both significantly lower than [(136.4±17.1)ng/mL and (138.5±17.3)ng/mL, respectively, P<0.05] in CHB patients with NAFL; the CAP in CHB patients with NASH was (255.8±26.9)dB/m, much lower than [(269.4±30.1)dB/m, P<0.05] in CHB patients with NAFL. Conclusion The oral administration of PPC for auxiliary treatment at base of ETV antiviral therapy in patients with CHB and NASH could help improve biochemical parameters back to normal, and ameliorate hepatic steatosis.

Key words: Hepatitis B, Nonalcoholic steatohepatitis, Entecavir, Polyene phosphatidylcholine, Therapy

罗良德, 任成果, 王守军, 邓颖春. 恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 333-336.

Luo Liangde, Ren Chengguo, Wang Shoujun, et al. Combination of entecavir and polyene phosphatidylcholine therapy in the treatment of patients with chronic hepatitit B and NASH[J]. Journal of Practical Hepatology, 2024, 27(3): 333-336.

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恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究^*

Combination of entecavir and polyene phosphatidylcholine therapy in the treatment of patients with chronic hepatitit B and NASH

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