目的 探討腺苷蛋氨酸聯(lián)合恩替卡韋對(duì)膽汁淤積型乙型病毒性肝炎（乙肝）的預(yù)后影響。方法 選擇2016年9月— 2019年2月在開(kāi)封市中心醫(yī)院收治的膽汁淤積型乙肝患者172例。根據(jù)治療方法的不同將患者分為對(duì)照組（72例）和觀察組（100例）。對(duì)照組口服恩替卡韋分散片，0.5 mg/d。觀察組在對(duì)照組治療的基礎(chǔ)上使用注射用丁二磺酸腺苷蛋氨酸，1 g/d。兩組均治療觀察8周。觀察兩組患者的臨床療效，同時(shí)比較兩組患者的肝功能指標(biāo)、乙肝病毒的脫氧核糖核酸（HBVDNA）陰轉(zhuǎn)情況和不良反應(yīng)發(fā)生情況。結(jié)果 治療后，觀察組的總有效率為97.0%，顯著高于對(duì)照組的80.6%（P<0.05）。兩組治療后的血清丙氨酸氨基轉(zhuǎn)移酶（ALT）、天冬氨酸氨基轉(zhuǎn)移酶（AST）水平均顯著低于治療前（P<0.05），且觀察組各肝功能指標(biāo)水平顯著低于對(duì)照組（P<0.05）。治療后，觀察組的HBV-DNA轉(zhuǎn)陰率為99.0%，顯著高于對(duì)照組的90.3%（P<0.05）。兩組治療期間的不良反應(yīng)發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 腺苷蛋氨酸聯(lián)合恩替卡韋治療膽汁淤積型乙肝能提高HBV-DNA轉(zhuǎn)陰率與治療效果，促進(jìn)患者肝功能的改善，且不會(huì)增加不良反應(yīng)，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the prognostic effects of ademetionine combined with entecavir on cholestasis-type hepatitis B. Methods Patients (172 cases) with cholestasis-type hepatitis B in Kaifeng Central Hospital from September 2016 to February 2019 were selected. According to different treatment methods, patients were divided into control group (72 cases) and observation group (100 cases). Patients in the control group were po administered with Entecavir Dispersible Tablets, 0.5 mg/d. Patients in the observation group were iv administered with Ademetionine 1,4-Butanedisulfonate for Injection on the basis of treatment, 1 g/d. Both groups were observed for 8 weeks. After treatment, the clinical efficacy in two groups were observed, and the indicators of liver function, HBV DNA negative conversion, and adverse reactions were compared between two groups. Results After treatment, the total effective rate of the observation group was 97.0%, which was significantly higher than 80.6% of the control group (P<0.05). After treatment, serum ALT and AST levels in two groups were significantly decreased (P<0.05), and the levels of liver function indicators in the observation group were also significantly lower than those in the control group (P<0.05). After treatment, the HBVDNA negative conversion rate in the observation group was 99.0%, which was significantly higher than 90.3% in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between two groups during treatment. Conclusion Ademetionine combined with entecavir in treatment of cholestasis-type hepatitis B can improve the negative conversion rate of HBV-DNA and therapeutic effect, promote the improvement of liver function in patients, and will not increase adverse reactions, which has certain clinical application value.

R975

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（201701027）