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[目的]探讨恩替卡韦(ETV)单药和联合聚乙二醇干扰素α-2a(PEG-IFNα-2a)对慢性乙型肝炎肝纤维化患者血小板比率指数(APRI)和肝脏弹性硬度(LSM)值的影响.[方法]选择2013年10月至2014年12月间就诊于延边大学附属医院门诊的慢性乙型肝炎肝纤维化患者28例,随机分为ETV组(10例)和ETV+PEG-IFNα-2a组(18例).ETV组饭后2 h空腹口服给予ETV分散片,每次0.5 mg,每日1次,疗程78周;ETV+PEG-IFNα-2a组口服给予ETV分散片,用法与ETV组相同,26周时开始皮下注射给予PEG-IFNα-2a,每次180μg,每周1次,52周,总疗程78周.检测两组治疗前和治疗后26,52,78周时的血常规及肝功能指标水平,利用FibroTouch测定LSM值.[结果]ETV组APRI呈总体下降趋势,其中以26周时下降幅度最为明显,与0周比较,26,52,78周时明显下降(P=0.019,P=0.010,P=0.010);ETV+PEG-IFNα-2a组26周时的APRI显著降低,而52周时较26周升高,78周时又明显下降,0周时的APRI显著高于26和78周(P=0.000,0.007),52周时的APRI显著高于26和78周(P=0.000,0.001);两组52,78周时的APRI间差异均有统计学意义(P=0.000,0.043).ETV组和ETV+PEG-IFNα-2a组LSM值均呈总体下降趋势,两组均在26周时下降最为明显,但各访视点间差异均无统计学意义(P>0.05);两组各个访视点LSM值间差异亦均无统计学意义(P>0.05).[结论]ETV单药和ETV+PEG-IFNα-2a联合用药在治疗26周内均可迅速降低慢性乙型肝炎肝纤维化患者的APRI和LSM值,持续治疗可将APRI和LSM值控制在较低水平;排除PEG-IFNα-2a不良反应情况下,两种治疗方案疗效间无明显差异.
[Objective] To investigate the effects of entecavir (ETV) monotherapy and combined pegylated interferon α-2a (PEG-IFNα-2a) on platelet ratio index (APRI) and liver elastic stiffness (LSM) in patients with chronic hepatitis B liver fibrosis [Methods] Twenty-eight patients with chronic hepatitis B liver fibrosis who were treated at Yanbian University Hospital from October 2013 to December 2014 were randomly divided into ETV group (n = 10) and ETV + PEG -EIF-2a group (n = 18) .ETV group was administered orally with ETV dispersible tablets orally 0.5 mg once daily for 78 weeks after ingestion. ETV dispersion tablets were given orally to ETV + PEG-IFNα-2a group , The same usage as the ETV group, beginning at 26 weeks of subcutaneous injection of PEG-IFNα-2a, each 180μg, once a week, 52 weeks, the total duration of 78 weeks.After treatment, two groups were detected 26,52,78 Weeks of blood and liver function indicators, the use of FibroTouch LSM value. [Results] The APRI showed an overall downward trend in ETV group, of which the decline was most obvious at 26 weeks, compared with 0 weeks, 26,52,78 weeks (P = 0.019, P = 0.010, P = 0.010). The APRI at 26 weeks in ETV + PEG-IFNα-2a group was significantly lower than that in 26 weeks after 52 weeks and decreased significantly at 78 weeks APRI was significantly higher at week 26 than at week 26 The APRI at week 52 was significantly higher than that at week 26 and week 78 (P = 0.000, 0.001) at 78 weeks (P = 0.000 and 0.007). There was a significant difference in APRI between the two groups at week 52 and week 78 (P = 0.000, , 0.043). The LSM values of ETV group and ETV + PEG-IFNα-2a group showed an overall decreasing trend, with the most obvious decrease in both groups at 26 weeks, but there was no significant difference between the two groups (P> 0.05) (P> 0.05). [Conclusion] The combination of ETV alone and ETV + PEG-IFNα-2a can reduce chronic B APRI and LSM in patients with hepatitis and liver fibrosis, continuous treatment can be APRI and LSM values ?? to control the low level; exclude PEG-IFNα-2a adverse reactions, the two treatment regimens no significant difference between the efficacy.