博路定治疗肝硬化临床与病理随访(论文).docVIP

博路定治疗肝硬化临床与病理随访 林国贤 黄庆华 林玉英 吴智宏 何雄志 叶向阳 邱荣仙 【摘要】目的 观察恩替卡韦（博路定）治疗肝硬化患者HBVDNA、HBeAg及肝脏病理学变化。方法 门诊及住院的HBV DNA阳性肝硬化患者94例，其中失代偿22例，经肝穿活检病理确诊46例。给予博路定0.5mg.qd-1，肝功异常者同时予以保肝降酶治疗，治疗时间24W以上。观察患者HBVDNA、HBeAg及肝脏病理学变化。结果 94例患者中HBeAg阳性37例，阴性57例；治疗时间（24～144）W，中位69 W。HBeAg阳性者在24W、48W、96W及144W，HBV DNA检测不到率分别为86.5%、86.2%、90.0%和83.3%；HBeAg阴转率分别为40.5%、58.6%、80.0%和50.0%，HBeAg血清转换率分别为10.8%、37.9%、40.0%和50.0%。HBeAg阴性者，HBV DNA检测不到率分别为87.7%、89.5%、100%和100%。22例患者治疗48W后行二次肝穿活检，1例治疗96W第三次肝穿活检。肝穿病理显示，22例患者肝组织炎症活动度、纤维化程度均有不同程度好转，16例（72.7%）患者假小叶消失，6例（27.3%）仍可见到假小叶，但数量明显减少。二例男性失代偿肝硬化患者，治疗24W后发现肝癌，继续应用博路定，其中一例102W病故。结论 博路定对肝硬化具有良好的抗病毒疗效，经过长期治疗，患者病毒学、血清学及病理学均有明显改善；部分肝硬化患者的病理可以逆转，假小叶消失；但个别患者仍会进展为肝细胞癌。 【关键词】 慢性乙型肝炎；肝硬化；恩替卡韦；肝脏病理学 Clinical and Pathological Follow-up of Treating Liver Cirrhosis with Baraclude LIN Guo-xian, HUANG Qing-hua, LIN Yu-ying, WU Zhi-hong, HE Xiong-zhi, YE Xiang-yang, QIU Run-xian. Department of Infectious Diseases, affiliated Hospital of Putian Colloge（teaching Hospital of Fujian Medical Universty）, Putian，Fujian ，China，351100 Corresponding author: LIN Guo-xian, Email: lingx609@ 作者单位：351100莆田莆田学院附属医院感染性疾病科 林国贤Email：lingx609@Objective To observe HBVDNA, HBeAg and liver pathological changes for cirrhosis patients treated with entecavir (baraclude). Methods 94 cases of positive HBV DNA cirrhosis from both outpatient and inpatient, of whom 22 cases suffered from decompensation, and 46 cases were diagnosed pathologically through liver puncture biopsy, were given baraclude(0.5mg.qd), and those with abnormal liver function were given liver-protecting and enzymes-decreasing treatment at the same time; the time of therapy was more than 24W. HBVDNA, HBeAg and liver pathological changes of the patients were observed. Results Among the 94 cases, 37 cases showed positive HBeAg，57cases with negative HBerAg；the time was between 24W to 144W，and the meso-position 69W, and that for positive HBeAg was 24W, 48W, 96W and 144W; the failure detection rates for HBV DNA