Effects of entecavir on liver fibrosis indices in patients with hepatogenous diabetes
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摘要: 目的观察恩替卡韦治疗肝源性糖尿病对肝纤维化指标的影响。方法选择2008年6月至2013年8月青岛市传染病医院收治的乙型肝炎肝硬化伴肝源性糖尿病患者98例,分为治疗组和对照组各49例,所有患者均给予糖尿病饮食及综合护肝、对症、支持治疗。治疗组给予恩替卡韦0.5 mg,1次/d,口服,52周后观察血清肝纤维化及Fibro Scan检测的肝硬度(LSM)值的差异。计量资料两组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗52周后治疗组血清肝纤维化的4项指标、层黏连蛋白、Ⅳ型胶原、透明质酸、Ⅲ型前胶原蛋白较对照组差异有统计学意义(t=2.71,P<0.01;t=3.53,P<0.01;t=2.34,P<0.05;t=2.28,P<0.05)。两组病毒学应答率和糖尿病控制率差异均有统计学意义(χ2值分别为12.69,7.14,P值均<0.01)。LSM值降低显著(t=3.22,P<0.01),同时肝功能指标(TBil、ALT、Alb)和空腹血糖等指标较对照组好转,差异有统计学意义(t=5.53,P<0.01;t=4.73,P<0.01;t...Abstract: Objective To investigate the effects of entecavir on liver fibrosis indices in patients with hepatogenous diabetes. Methods A total of 98 patients, who were admitted to our hospital from June 2008 to August 2013, were diagnosed with hepatitis B cirrhosis complicated by hepatogenous diabetes, and were randomly and equally divided into treatment group and control group. All patients were given diabetic diet, as well as liver protection, symptomatic treatment, and supportive care. The treatment group was orally administered entecavir 0. 5 mg once daily for 52 weeks. Live fibrosis indices and Fibro Scan value were analyzed after treatment. Comparison of continuous data between the two groups was made by t test, and comparison of categorical data was made by χ2test. Results Compared with the control group, the treatment group had significantly lower levels of laminin, type Ⅳ collagen, hyaluronic acid, and type Ⅲ procollagen (t = 2. 71, P < 0. 01; t =3. 53, P < 0. 01; t = 2. 34, P < 0. 05; t = 2. 28, P < 0. 05) , a significantly lower Fibro Scan value (t = 3. 22, P < 0. 01) , a significantly higher serum HBV DNA clearance rate (χ2= 12. 69, P < 0. 01) , a significantly lower blood glucose level (t = 16. 01, P < 0. 01) , significantly lower levels of total bilirubin and alanine aminotransferase (t = 5. 53, P < 0. 01; t = 4. 73, P < 0. 01) , and a significantly higher albumin level (t = 2. 42, P < 0. 05) . Conclusion Entecavir leads to improvements in liver fibrosis indices, Fibro Scan value, viral DNA replication, blood glucose, and liver function indices and has good efficacy in HBV DNA-positive hepatitis B cirrhosis patients complicated by hepatogenous diabetes.
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Key words:
- hepatitis B, chronic /
- liver cirrhosis /
- diabetes mellitus /
- entecavir
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[1]TAK P, TENKATE F.Remission of active diabetic hepatitis after correction of hyperglycemia[J].Liver, 1993, 13 (4) :183-187. [2]LI Q, DENG CL.Hyperglycemia, hepatic stellate cell and liver fibrosis[J].Med Recapitulate, 2008, 14 (6) :888-890. (in Chinese) 李芹, 邓存良.高血糖、肝星状细胞与肝纤维化[J].医学综述, 2008, 14 (6) :888-890. [3]STENTZ FB, UMPIERREZ GE, CUERVO R, et al.Proin flammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises[J].Diabetes, 2004, 53 (8) :2079-2086. [4]NAKAI T, TANIMURA H, HIROKAWA F, et al.Altered hepatic hemodynamics and improved liver function following intrahepatic vascular infusion of prostaglandin E1[J].Gastroenterol, 1998, 33 (3) :362-367. [5]ZHANG WW, WANG XQ, LI Y.Insulin resistance and serum growth hormone level in patients with cirrhosis[J].World Chin J Dig, 2002, 10 (10) :1180-1183. (in Chinese) 张卫卫, 王学清, 李岩.肝硬化胰岛素抵抗及血清生长激素水平的研究[J].世界华人消化杂志, 2002, 10 (10) :1180-1183. [6] LI QF, LIU YN, YANG HL, et al.Effects of adefovir dipivoxil combined with lamivudine on HBV DNA duplication and T cell subsets in chronic hepatitis B patients[J].Int J Virol, 2014, 21 (4) :168-171. (in Chinese) 黎秋芬, 刘亚南, 杨红丽, 等.阿德福韦酯联合拉米夫定对CHB患者HBV DNA复制和T细胞亚群的影响[J].国际病毒学杂志, 2014, 21 (4) :168-171. [7]Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology of Chinese Medical Association.The programme of prevention and cure for viral hepatitis[J].Chin J Hepatol, 2000, 8 (6) :324-329. (in Chinese) 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329. [8]HAN YM, LI ST.Clinical Hepatology[M].Jinan:Shandong Science and Technology, 2004:6. (in Chinese) 韩硬海, 李树桐.临床肝脏病学[M].济南:山东科学技术出版社, 2004:6. [9]EDVARDSSON U, von L WENHIELM HB, PANFILOV O, et al.Hepatic protein expression of lean mice and obese diabetic mice treated with peroxisome proliferator-activated receptor activators[J].Proteomics, 2003, 3 (4) :468-478. [10]WANG HN, WEN WB.Advances in clinical research on hepatogenous diabetes[J].J Pract Hepatol, 2003, 6 (1) :59-60. (in Chinese) 王华宁, 温伟波.肝源性糖尿病临床研究进展[J].实用肝脏病杂志, 2003, 6 (1) :59-60. [11]DENG LN, HOU HB, LI CP.Clinical efficacy of entecavir in treating liver fibrosis among patients with hepatitis B[J].Chin J Coal Industry Med, 2008, 11 (7) :1035-1036. (in Chinese) 邓丽宁, 侯宏波, 李纯平.恩替卡韦治疗乙型肝炎肝纤维化的临床观察[J].中国煤炭工业医学杂志, 2008, 11 (7) :1035-1036. [12]XIE SB, YAO JL, ZHENG RQ, et al.A study on the relationship between serum levels of hyaluronic acid, typeⅢprocollagen, typeⅣcollagen and hepatic fibrosis[J].Chin J Infect Dis, 1999, 17 (4) :238. (in Chinese) 谢仕斌, 姚集鲁, 郑荣琴, 等.血清透明质酸、Ⅲ型前胶原、Ⅳ型胶原水平与肝纤维化的关系[J].中华传染病杂志, 1999, 17 (4) :238. [13]TAN B, HE WF, WEN FY.The diagnostic value of the stage of liver fibrosis and glutamic acid decarboxylase antibody in hepatogenic[J].Med Philosophy:Clinical Desicion Making Forum Edition, 2008, 29 (11) :26-27, 42. (in Chinese) 谭斌, 何伟锋, 温帆渊.肝纤维化分期和谷氨酸脱羧酶抗体在肝源性糖尿病中的诊断价值[J].医学与哲学:临床决策论坛版, 2008, 29 (11) :26-27, 42. [14]LI CZ, WAN MB, ZENG MD, et al.A preliminary study of the combination of noninvasive parameters in the diagnosis of liver fibrosis[J].Chin J Hepatol, 2001, 9 (5) :261-263. (in Chinese) 李成忠, 万漠彬, 曾民德, 等.非创伤性诊断指标优势组合对肝纤维诊断价值的初步研究[J].中华肝脏病杂志, 2001, 9 (5) :261-263. [15]CHENG JY, MA H.Research progress in noninvasive diagnosis of liver fibrosis in patients with chronic liver diseases[J].J Clin Hepatol, 2014, 30 (2) :178-181. (in Chinese) 程捷瑶, 马红.慢性肝病肝纤维化无创诊断的研究进展[J].临床肝胆病杂志, 2014, 30 (2) :178-181.
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