目的 探讨氢化可的松联合恩替卡韦对早期乙型肝炎肝衰竭免疫功能及炎性因子单核细胞趋化蛋白-1(monocyte chemotactic protein 1，MCP-1)、血细胞介素-1β(interleukin-1β，IL-1β)及高迁移率族蛋白B1(high mobility group protein B1，HMGB1)的影响。方法 选取郑州大学第一附属医院2021年12月-2022年12月收治的100例早期乙型肝炎肝衰竭患者，根据治疗方法不同分组，应用恩替卡韦治疗的50例作为对照组，应用氢化可的松联合恩替卡韦治疗的50例作为观察组，对比两组炎性因子、免疫功能、治疗1月后的乙肝病毒脱氧核糖核酸(HBV-DNA)转阴率、并发症发生率、血液生化指标及疗效。结果 观察组总有效率为94。00％，高于对照组的78。00％，差异有统计学意义(P＜0。05);两组治疗前血液生化和HBV-DNA指标对比无统计学意义(P＞0。05)，观察组治疗后总胆红素(total bilirubin，TBIL)、丙氨酸转氨酶(alanine transaminase，ALT)、天冬氨酸转氨酶(aspartate aminotransferase，AST)、HBV-DNA 分别为(106。77±25。09)μmol/L、(96。11±22。38)U/L、(101。55±30。29)U/L 及(3。08±0。85)×103cps/mL，低于对照组，PTA指标(75。89±5。36)％，高于对照组，差异有统计学意义(P＜0。05);观察组HBV-DNA转阴率90。00％，高于对照组的72。00％，差异有统计学意义(P＜0。05)，并发症发生率两组比较无统计学意义(P＞0。05);两组治疗前免疫功能指标对比无统计学意义(P＞0。05)，观察组治疗后CD4+、CD4+/CD8+指标高于对照组，CD8+指标低于对照组，差异有统计学意义(P＜0。05);两组治疗前炎性因子HMGB1、IL-1β及MCP-1水平对比无统计学意义(P＞0。05)，治疗后均降低，且观察组因子水平均低于对照组(P＜0。05);观察组住院、黄疸消退及临床症状改善时间短于对照组，差异有统计学意义(P＜0。05)。结论 针对乙肝肝衰竭患者应用糖皮质激素联合恩替卡韦的实际治疗效果良好，值得临床推广应用。
Effects of hydrocortisone combined with Entecavir on immune function and inflammatory factors MCP-1,1L-1β and HMGB1 in early hepatitis B failure
Objective To investigate the effect of hydrocortisone combined with entecavir on the immune function and in-flammatory cytokine chemotactic protein 1(MCP-1),interleukin-1β(interleukin-1β)and High Mobility Group Pro-tein B1(HMGB1)in early hepatitis B liver failure.Methods A total of 100 patients with early hepatitis B liver failure who were treated in the First Affiliated Hospital of Zhengzhou University from December 2021 to December 2022 were se-lected for observation.According to the differences in treatment methods,50 patients treated with Entecavir were selected as the control group,and 50 patients treated with Entecavir combined with hydrocortisone were selected as the observation group.Inflammatory factors,immune function,negative rate of HBV deoxyribonucleic acid after 1 month of treatment,complication rate,blood biochemical indexes and curative effect were compared between the two groups.Results The total effective rate of the observation group was 94.00％,higher than that of the control group(78.00％),and the difference was statistically significant(P＜0.05).There was no statistical significance in blood biochemical and HBV-DNA inde-xes between the two groups before treatment(P＞0.05).After treatment,total bilirubin(TBIL)and Alanine transami-nase(alanine transaminase)aspartate aminotransferase,(AST),HBV-DNA in the observation group were(106.77± 25.09)µmol/L,(96.11±22.38)U/L,(101.55±30.29)U/L and(3.08±0.85)×103cps/mL,which were lower than the control group.PTA index was(75.89±5.36)％.Higher than control group,the difference was statistically sig-nificant(P＜0.05);The negative HBV-DNA conversion rate in the observation group was 90.00％,higher than that of the control group(72.00％),the difference was statistically significant(P＜0.05),and the complication rate was not statistically significant between the two groups(P＞0.05).There was no statistical significance in immune function inde-xes between the two groups before treatment(P＞0.05).After treatment,CD4+and CD4+/CD8+indexes in the observa-tion group were higher than those of the control group,and CD8+indexes were lower than those of the control group,with statistical significance(P＜0.05).There was no statistical significance in the levels of inflammatory factors HMGB1,IL-1β and MCP-1 between the two groups before treatment(P＞0.05),and the levels of inflammatory factors in the observation group were lower than those of the control group after treatment(P＜0.05).The time of hospitalization,jaun-dice resolution and clinical symptoms improvement in the observation group was shorter than that of the control group,and the difference was statistically significant(P＜0.05).Conclusion Combined entecavir with hydrocortisone has good ther-apeutic effect on patients with hepatitis B liver failure and is worthy of clinical application.
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