论文部分内容阅读
目的探讨拉米夫定与胸腺肽序贯联合治疗HBV DNA阳性慢性重型乙型肝炎和单独使用拉米夫定的疗效差异。方法将入院时HBV DNA阳性的慢性重型乙型肝炎患者随机分为治疗组61例和对照组61例,治疗组先给予拉米夫定4周,然后联合使用胸腺肽至12周,对照组仅给予拉米夫定治疗,比较两组患者12周生存率的差异,同时比较两组治疗12周时总胆红素(TB)、国际标准化比值(INR)、终末期肝病模型(MELD)、HBV DNA转阴率及T淋巴细胞亚群变化的差异,以及两组12周内合并感染的差异。结果 (1)治疗组12周生存率为77.05%(47/61),对照组为68.85%(42/61),两组比较差异无统计学意义(χ2=0.83,P=0.36)。(2)12周时治疗组TB、INR、MELD、CD4+/CD8+分别为(71.31±55.84)μmol/L、1.23±0.19、11.72±4.29、1.85±0.63,对照组分别为(148.58±159.25)μmol/L、1.45±0.73、15.53±7.49、1.56±0.59。两组比较差异均有统计学意义(P<0.05)。(3)12周时治疗组HBV DNA转阴率为85.11%(40/47),对照组为73.81%(31/42),两组比较差异无统计学意义。(4)12周内治疗组及对照组总感染病例数分别为26例(42.62%)及42例(68.85%),两组发生自发性腹膜炎分别为15例(24.59%)及28例(45.90%),两组在总感染病例数及自发性腹膜炎方面比较差异有统计学意义(P<0.05)。结论序贯联合治疗在改善慢性重型乙型肝炎患者的TB、INR、MELD分值及减少感染方面优于单独使用拉米夫定治疗。
Objective To investigate the efficacy of sequential combination of lamivudine and thymosin in the treatment of HBV DNA-positive chronic severe hepatitis B and lamivudine alone. Methods HBV DNA positive chronic severe hepatitis B patients were randomly divided into treatment group (61 cases) and control group (61 cases). Patients in treatment group were given lamivudine for 4 weeks, and then combined with thymosin for 12 weeks. Control group was given only Lamivudine treatment. The difference of 12-week survival rate was compared between the two groups. At the same time, the total bilirubin (TB), international normalized ratio (INR), end-stage liver disease model (MELD), HBV DNA Negative rate and T lymphocyte subsets changes, as well as the difference between the two groups within 12 weeks of co-infection. Results (1) The 12-week survival rate was 77.05% (47/61) in the treatment group and 68.85% (42/61) in the control group. There was no significant difference between the two groups (χ2 = 0.83, P = 0.36). (2) At 12 weeks, the levels of TB, INR, MELD and CD4 + / CD8 + in the treatment group were (71.31 ± 55.84) μmol / L and 1.23 ± 0.19 and 11.72 ± 4.29 and 1.85 ± 0.63 respectively, while those in the control group were (148.58 ± 159.25) μmol /L, 1.45 ± 0.73, 15.53 ± 7.49, 1.56 ± 0.59. The differences between the two groups were statistically significant (P <0.05). (3) At 12 weeks, the negative rate of HBV DNA in the treatment group was 85.11% (40/47), while the control group was 73.81% (31/42). There was no significant difference between the two groups. (4) In the 12 weeks, the total number of infections in the treatment group and the control group were 26 cases (42.62%) and 42 cases (68.85%) respectively. The incidence of spontaneous peritonitis in 15 cases (24.59%) and 28 cases (45.90% %), The two groups in the total number of cases of infection and spontaneous peritonitis, the difference was statistically significant (P <0.05). Conclusion Sequential combination therapy is superior to lamivudine alone in improving TB, INR, MELD scores and reducing infection in patients with chronic severe hepatitis.