张瑜　路青华　曹海芳　张生荣

[關键词] 恩替卡韦;干扰素;乙肝肝硬化;肝纤维化;细胞免疫功能

[中图分类号] R969.4          [文献标识码] B          [文章编号] 1673-9701（2021）23-0083-04

Clinical effect of entecavir and entecavir combined with interferon in the treatment of hepatitis B cirrhosis and its influence on liver fibrosis and cellular immune function

ZHANG Yu1   LU Qinghua1   CAO Haifang1   ZHANG Shengrong2

1.Ward 1 of Department of Liver Diseases， the Fourth People′s Hospital of Qinghai Province， Xi′ning   810000， China; 2.Department of Science and Education， the Fourth People′s Hospital of Qinghai Province， Xi′ning   810000， China

[Abstract] Objective To investigate the clinical effect of entecavir and entecavir combined with interferon in the treatment of hepatitis B cirrhosis and the influence on liver fibrosis and cellular immune function. Methods A total of 105 patients admitted to our hospital from February 2018 to August 2020 were selected as the research subjects and randomly divided into the observation group（n=53） and the control group（n=52）. The control group was treated with entecavir， while the observation group was treated with interferon on this basis of entecavir treatment. The clinical efficacy， indicators of liver fibrosis（such as HA， LN， PCⅢ and CⅣ）， and indicators of cellular immune function（such as CD4+， CD8+ and CD4+/CD8+） of the two groups were observed and compared. Results The overall clinical efficacy of the observation group was better than that of the control group， and the difference was statistically significant（Z=5.157， P=0.000）; the total clinical effective rate was 94.34%， which was significantly higher than that in the control group（78.85%）， and the difference was statistically significant（χ2=5.453， P=0.020）. After treatment， the levels of HA， LN， PCⅢ， and CⅣ in the two groups decreased more obviously than before treatment（P<0.05）， and the levels of various indicators in the observation group were significantly lower than those in the control group，and the difference was statistically significant（P=0.000）.  After treatment， the levels of CD4+ and CD4+/CD8+ in the two groups increased more obviously than before treatment（P<0.05）， and the levels of CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group， and the difference was statistically significant（t=5.406， P=0.000; t=8.021， P=0.000）. Conclusion The combination of entecavir and interferon has a significant clinical effect in the treatment of hepatitis B cirrhosis. It can effectively delay the process of liver fibrosis and the disease process， and improve the body′s cellular immune function. Therefore， it is worthy of popularization and application.

[Key words] Entecavir; Interferon; Hepatitis B cirrhosis; Liver fibrosis; Cellular immune function

乙肝肝硬化属于消化内科常见疾病，由慢性乙型病毒性肝炎发展而来[1]。数据显示，全球有慢性乙型肝炎感染者约2.4亿人，我国每年死于乙型肝炎病毒感染所致的肝硬化、肝癌及肝衰竭者超过100万人[2]。乙肝肝硬化患者早期，肝脏代偿功能较强，临床多无明显症状体征;随着疾病进展，疾病后期以肝功能损害及门脉高压为主要表现，可同时伴有多器官受累，出现消化道出血、肝性脑病、脾功能亢进、腹水等症状，严重威胁患者生命健康安全[3]。因此，探讨有效的治疗方式具有重要意义，以逆转或阻止肝纤维化进程，延长患者生存期限，提高患者生活质量。

乙肝肝硬化的临床治疗以阻止或延缓肝功能失代偿及肝癌发生为主要原则[4]。治疗方式以抗病毒为主，包括干扰素及核苷类似物两类[5]。核苷类似物以恩替卡韦为代表，具有作用强、耐药性低、安全性高等特点，可有效抑制乙型肝炎病毒复制，减少病毒对肝细胞的免疫炎症损伤作用;但该药物血清转换率低，单独使用具有一定局限性[6]。干扰素可与受体有效结合，抗病毒基因激活后抑制乙型肝炎病毒的复制，同时增强以T淋巴细胞为主的机体免疫功能[7]。我院于2018年2月至2020年8月共收治乙肝肝硬化患者105例，采用恩替卡韦和联合干扰素进行治疗，现报道如下。

1 资料与方法

1.1 一般资料