恩替卡韦联合复方嗜酸乳杆菌治疗CHB合并NAFLD患者疗效及其对血清相关酶系的影响

doi:10.3969/j.issn.1672-5069.2020.05.008

摘要/Abstract

摘要： 目的探讨应用恩替卡韦联合复方嗜酸乳杆菌治疗慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病NAFLD)患者疗效及其血清血红素加氧酶(HO-1)、细胞色素P4502E1(CYP2E1)水平和胰岛素抵抗指数(IRI)的变化。方法 2017年7月～2019年5月我院收治的CHB合并NAFLD患者128例,随机分为对照组和观察组,每组64例。给予对照组患者恩替卡韦治疗,观察组患者在恩替卡韦治疗的基础上给予复方嗜酸乳杆菌治疗,两组均观察治疗6个月。采用ELISA法检测空腹血胰岛素和髓过氧化物酶(MPO)、HO-1和CYP2E1,使用彩色超声检查腹部,行脂肪肝分度。结果在治疗6个月观察结束时,观察组血清ALT水平为(38.2±10.5)U/L,血清AST水平为(35.6±9.7)U/L,显著低于对照组【分别为(53.9±13.8)U/L和(48.1±11.6)U/L,P<0.05】,而两组血清GGT水平无显著性差异【(73.9±15.4)U/L对(68.2±21.3) U/L,P>0.05】,两组血清HBV DNA水平也无显著性差异【(1.9±0.3)lgcopies/ml对(1.7±0.4)lgcopies/ml,P>0.05】;观察组血清总胆固醇(TC)水平为(4.2±0.5)mmol/L,甘油三脂(TG)水平为(1.7±0.3)mmol/L,IRI为(3.1±1.2),显著低于对照组【分别为(5.1±0.8)mmol/L、(2.3±0.4)mmol/L和(4.3±1.5),P<0.05】;观察组血清HO-1水平为(124.7±13.7)mg/mL,显著高于对照组【(103.2±10.4)mg/mL,P<0.05】,血清CYP2E1水平为(3.6±0.5)U/L】,血清MPO水平为(49.5±7.3)mg/mL,均显著低于对照组【分别为(5.1±0.8)U/L和(64.8±9.2)mg/mL,P<0.05】;治疗后,观察组肝脏脂肪变减轻发生率为20.3%,显著高于对照组的7.8%(P<0.05)。结论对于CHB合并NAFLD患者,在应用恩替卡韦抗病毒治疗的过程中,联合应用复方嗜酸乳杆菌可能帮助减轻胰岛素抵抗程度,协作改善血脂和肝功能指标,值得进一步观察。

关键词: 慢性乙型肝炎, 非酒精性脂肪性肝病, 恩替卡韦, 嗜酸乳杆菌, 治疗, 胰岛素抵抗指数 , ,

Abstract: Objective The aim of this study was to investigate the short-term efficacy of entecavir and lactobacillus acidophilus compound combination in the treatment of patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD). Methods 128 patients with CHB complicated by NAFLD were recruited in our hospital between July 2017 and May 2019, and were randomly divided into control and observation group, with 64 patients in each group. The patients in the control group were treated with entecavir and the patients in the observation group were treated with entecavir and lactobacillus acidophilus compound combination. The observation lasted for six months. Blood lipid indexes, heme oxygenase (HO-1), cytochrome P4502E1(CYP2E1) and myeloperoxidase (MPO) were detected by ELISA, and insulin resistance index (IRI) was calculated. The hepatic steatosis was evaluated by sonography. Results At the end of six month observation, serum alanine aminotransferase level in the observation group was (38.2±10.5)U/L, and serum aspartate aminotransferase level was (35.6±9.7)U/L, both significantly lower than [(53.9±13.8)U/L and (48.1±11.6)U/L, respectively, P<0.05】 in the control, while there was no significant differences as respect to serum GGT levels 【(73.9±15.4)U/L vs.(68.2±21.3) U/L, P>0.05】 or serum HBV DNA loads 【(1.9±0.3)lg copies/ml vs.(1.7±0.4)lg copies/ml, P>0.05】 between the two groups; serum total cholesterol level was (4.2±0.5)mmol/L, and serum triglyceride level was (1.7±0.3)mmol/L, IRI was (3.1±1.2), all significantly lower than 【(5.1±0.8)mmol/L,(2.3±0.4)mmol/L and (4.3±1.5), respectively, P<0.05】 in the control; serum HO-1 level was (124.7±13.7)mg/mL, significantly higher than 【(103.2±10.4)mg/mL, P<0.05】, while serum CYP2E1 level was (3.6±0.5)U/L】, and serum MPO level was (49.5±7.3)mg/mL, both much lower than 【(5.1±0.8)U/L and (64.8±9.2)mg/mL, P<0.05】 in the control; the incidence of improved hepatic steatosis in the observation was much higher than in the control (20.3% vs. 7.8%, P<0.05). Conclusion As for the patients with CHB and NAFLD, the administration of entecavir and lactobacillus acidophilus compound might be efficacious, and improve the liver functions and lipid metabolism, which could be related to the improvement of oxidative stress.

Key words: Hepatitis B, Nonalcoholic fatty liver diseases, Entecavir, Lactobacillus acidophilus, Insulin resistance index, Therapy

方奕, 陈毅雄, 裴冬萍, 操银针. 恩替卡韦联合复方嗜酸乳杆菌治疗CHB合并NAFLD患者疗效及其对血清相关酶系的影响[J]. 实用肝脏病杂志, 2020, 23(5): 634-637.

Fang Yi, Chen Yixiong, Pei Dongping, et al.. Short-term efficacy of entecavir and lactobacillus acidophilus compound combination in the treatment of patients with chronic hepatitis B and non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2020, 23(5): 634-637.

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