拉米夫定联合抗乙肝胎盘转移...炎疗效及对T淋巴细胞的影响_王潇.pdf

55临床研究 2023 年 05 月第 31 卷第 05 期作者简介：王潇，女，住院医师，本科。研究方向：感染疾病方面。临床治疗拉米夫定联合抗乙肝胎盘转移因子治疗慢性乙型肝炎疗效及对 T 淋巴细胞的影响王潇(南阳市中心医院 感染科，河南 南阳 473000)摘要：目的 探讨拉米夫定联合抗乙肝胎盘转移因子治疗慢性乙型肝炎疗效及对 T 淋巴细胞的影响。方法 选择2021 年 1 月至 2022 年 1 月南阳市中心医院收治的 90 例慢性乙肝患者，按照随机数字表法分为研究组与对照组各 45 例，两组患者均给予补充血浆、人血白蛋白，应用护肝、抗感染药物等常规对症治疗。对照组接受拉米夫定治疗，研究组使用拉米夫定及抗乙肝胎盘转移因子联合治疗。两组均持续治疗 12 周，比较治疗前后两组乙肝病毒标志物的阴转情况及肝功能指标 总胆红素(TBil)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆汁酸(TBA)，观察两组用药前后的免疫功能变化，并统计比较两组不良反应发生率。结果 治疗前，两组乙肝病毒标志物各项指标比较，差异无统计学意义(P 0.05)；治疗后，研究组 HBV-DNA 阴转、HBeAg 阴转、HBeAg/抗-HBe 人数占比明显高于对照组，差异有统计学意义(P 0.05)。治疗前，两组患者肝功能相关指标对比，差异无统计学意义(P 0.05)；治疗后，研究组 TBil、AST、ALT、TBA 水平低于对照组，差异有统计学意义(P 0.05)。治疗前，两组 T 淋巴细胞亚群各指标比较，差异无统计学意义(P 0.05)；治疗后，两组 CD3+、CD4+水平及 CD4+/CD8+值高于治疗前，CD8+水平低于治疗前，且研究组的改善幅度大于对照组，差异有统计学意义(P 0.05)。两组不良反应发生率比较，差异无统计学意义(P0.05)。结论 拉米夫定联合抗乙肝胎盘转移因子对慢性乙肝的治疗效果显著，有利于改善肝功能指标，调节免疫功能水平，进一步提高患者的临床治疗效果，且具有一定安全性。关键词：拉米夫定；抗乙肝胎盘转移因子；慢性乙型肝炎；T 淋巴细胞中图分类号：R512.62文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)05-0055-04Influence of Lamivudine and Anti-HBV Placenta Transfer Factors on the Curative Effects and T Lymphocyte for Chronic Hepatitis B Virus PatientsWANG Xiao(Department of Infectious Disease,Nanyang Central Hospital,Nanyang Henan 473000,China)Abstract:Objective To discuss the influence of lamivudine and anti-HBV placenta transfer factors on the curative effects and T lymphocyte for chronic hepatitis B virus patients.Methods A total of 90 patients with chronic hepatitis B admitted to Nanyang Central Hospital from January 2021 to January 2022 were selected and divided into the study group and the control group according to the method of random number table,with 45 patients in each group.The patients in both groups were given plasma supplementation,human albumin supplementation,liver protection,anti infection drugs and other conventional symptomatic treatment.The control group was treated with lamivudine,while the study group was treated with lamivudine and anti hepatitis B placental transfer factor.Both groups were treated continuously for 12 weeks.The negative conversion of hepatitis B B virus markers and liver function indicators total bilirubin(TBil),aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total bile acid(TBA)were compared between the two groups before and after treatment.The immune function changes of the two groups before and after treatment were observed,and the incidence of adverse reactions of the two groups were statistically compared.Results Before treatment,the hepatitis B virus markers between study group and control group were not significantly different(P 0.05);After treatment,the The proportion of HBV-DNA negative,HBeAg negative,and HBeAg/anti-HBe in the study group were significantly higher than that in the control group,with significant differences(P 0.05);Before treatment,the liver function indicators between groups were not significantly different(P 0.05);After treatment,TBil,AST,ALT and TBA contents in the study group were even lower than control group,with significant differences(P 0.05);Before treatment,T lymphocyte subpopulation indexes between two groups were not significantly different(P 0.05);After treatment,CD3+,CD4+and CD4+/CD8+values for two groups were higher than before,CD8+values for two groups were lower than before;the changing degrees in the study group were even higher than control group,with significant differences(P0.05);The adverse drug rates between groups were not significantly different(P 0.05).Conclusion Lamivudine combined with anti-hepatitis B placental transfer factor has a significant therapeutic effect on chronic hepatitis B,which is conducive to improving the liver function index,regulating the level of immune function,and further improving the clinical treatment effect of patients,and has certain safety.Key Words:lamivudine;anti-HBV placenta transfer factors;chronic hepatitis B virus;T lymphocyte乙肝是传染科常见的疾病之一，指乙型肝炎病毒持续感染大于 6 个月，最终导致肝脏发生不同程度炎症坏死、纤维化的慢性传染性疾病，同时乙肝也是导致肝癌的主要因素1-2。多数乙肝病毒感染患者早期不会出现较56Clinical Research,May 2023,Vol.31 No.05明显的症状，起病较为隐秘，但随着病情的不断恶化，患者会逐渐出现腹胀、食欲减退、尿黄、肝区不适等症状，若未得到及时有效地处理会出现肝肾综合征、肝性脑病、肝硬化等严重的并发症，进而导致患者死亡，故对于该疾病需给予足够重视，始终保持着早发现、早诊断、早治疗原则，谨防疾病恶化造成更严重损伤3。拉米夫定是一种核苷类似物抗 HBV 感染药，可有效抑制 HBV 复制，降低 HBV-DNA 水平，但随着应用年限的增长，有学者发现4该药单纯使用的耐药屏障较低，容易出现耐药性突变，导致用药效果不佳。抗乙肝胎盘转移因子是一种细胞因子类的生物制品，其成分包含小分子多肽、多核苷酸，可有效提高机体免疫力5。本研究为进一步探讨更加有效治疗慢性乙肝患者的方案及两种药物临床治疗的特性，对南阳市中心医院收治的 90 例慢性乙肝患者进行分组对照研究，观察拉米夫定联合抗乙肝胎盘转移因子治疗的临床效果，以期为未来该病的治疗提供参考依据，阐述如下。1资料与方法1.1一般资料选取南阳市中心医院收治的 90 例慢性乙肝患者为研究对象。采用随机数字表法分为对照组(N=45)和研究组(N=45)，两组一般资料比较，差异无统计学意义(P0.05)。见表 1。本研究经本院医学伦理委员会批准。纳入标准：所有患者均符合慢性乙型肝炎防治指南 2015 年版6诊断标准并经肝功能检查确诊；所有患者/家属对研究知情并签订同意书；检查资料完整者。排除标准：既往存在凝血功能障碍者；合并多项血液系统疾病者。表 1两组一般资料比较 n(%)，sx 组别例数性别年龄/岁体质量指数/(kg/m2)病程/月平均 HBV-DNA 含量/(copiesmL-1)男女对照组4525(55.56)20(44.44)33.054.4322.070.545.691.436.691.43研究组4522(48.89)23(51.11)33.084.5522.100.585.651.417.651.412/t0.4640.1440.2390.4260.426P0.4960.8860.8110.6710.6711.2方法两组患者的治疗内容包括补充血浆、人血白蛋白等，并给予足够的热量，补充维生素 B1 和维生素 C，使用护肝、促进干细胞再生、改善肝脏微循环以及抗病毒、抗感染等药物，同时注意维持水电解质平衡，积极预防各种并发症。对照组给予拉米夫定 葛兰素史克(中国