本文選題：慢性HBV感染　切入點：抗病毒治療　出處：《蘭州大學(xué)》2014年碩士論文

【摘要】：背景：慢性乙型肝炎病毒(hepatitis B virus, HBV)感染呈世界性流行,且我國為乙肝大國。目前抗病毒治療是慢性HBV感染的關(guān)鍵治療和最有效治療,可抑制病毒復(fù)制、促進肝臟病變恢復(fù)、減少或延緩并發(fā)癥的發(fā)生及提高患者生活質(zhì)量。目前最常用抗病毒藥物為核苷類藥物。由于核苷類藥物抗病毒治療時間長、社會負擔(dān)重,優(yōu)化其治療方案是臨床亟待解決的課題。近年來,采用聯(lián)合治療及個體化治療的策略已逐漸成為國際共識。慢性HBV感染可導(dǎo)致肝硬化、肝細胞癌(hepatocellular carcinoma, HCC)等嚴重并發(fā)癥,嚴重威脅人類健康,而肝纖維化是慢性HBV感染走向肝硬化的必經(jīng)途徑,對其進行監(jiān)測、早期診治可以有效阻止肝硬化等并發(fā)癥的發(fā)生,近幾年無創(chuàng)診斷肝纖維化成為研究熱點。我國90%以上的HCC是由HBV感染引起,其起病隱匿、進展迅速、發(fā)現(xiàn)時多已失去手術(shù)機會及預(yù)后差,HBV致HCC發(fā)病機理、抗病毒阻止肝癌發(fā)生的療效等仍在探討中。 目的：系統(tǒng)評價替比夫定聯(lián)合阿德福韋酯治療慢性乙型肝炎(chronic hepatitis B, CHB)的療效及安全性,為臨床實踐與研究提供參考；了解在慢性HBV感染病程中監(jiān)測肝纖維化的意義及瞬時彈性成像診斷肝纖維化的最新研究進展；探討慢性HBV感染致HCC的主要發(fā)病機理和臨床診治,及慢性HBV感染抗病毒治療阻止肝癌發(fā)生的療效與影響因素,為HCC的預(yù)防、早期發(fā)現(xiàn)及診療等作出一定貢獻。 方法：應(yīng)用系統(tǒng)評價方法,計算機檢索Cochrane Library、PubMed、EMBASE、 Web of Science、CBM、CNKI、WANFANG八大數(shù)據(jù)庫,同時輔以其他檢索,收集所有相關(guān)的隨機對照試驗(randomized controlled trial, RCT);由兩位評價員按照研究計劃書進行文獻篩選和資料提取,并對納入文獻進行質(zhì)量評價后,使用RevMan5.1軟件進行Meta分析。采用綜述方法研究慢性HBV感染相關(guān)性肝纖維化的監(jiān)測意義及肝纖維化、肝癌的有關(guān)診治進展�；仡櫺苑治鎏m州大學(xué)第一醫(yī)院東崗院區(qū)肝病中心在2012年10月-2013年6月收治的6例慢性HBV感染者在規(guī)范抗病毒治療期間出現(xiàn)HCC的相關(guān)臨床資料。 結(jié)果：系統(tǒng)評價共納入11篇RCT,包括1010例患者。試驗組采用替比夫定聯(lián)合阿德福韋酯治療,對照組采用單藥替比夫定或單藥阿德福韋酯治療。Meta分析結(jié)果顯示：除試驗組對比單藥替比夫定組的48周ALT復(fù)常率外,在12周、24周和48周的HBV DNA陰轉(zhuǎn)率、HBeAg陰轉(zhuǎn)率以及ALT復(fù)常率等各項指標(biāo)方面,試驗組均優(yōu)于單藥替比夫定組或單藥阿德福韋酯組(P0.05)；定性分析結(jié)果顯示試驗組的耐藥發(fā)生率最低,且試驗組并不增加藥物不良反應(yīng)。 對慢性HBV感染者進行肝纖維化監(jiān)測、評估并及時給予干預(yù)措施使其逆轉(zhuǎn)可有效阻止肝硬化等并發(fā)癥的發(fā)生；瞬時彈性成像是診斷肝纖維化的一種新型、快速方便、無創(chuàng)、經(jīng)濟、可重復(fù)的診斷技術(shù)。HBV致HCC的發(fā)病機理非常復(fù)雜,目前尚未完全闡明,主要包括直接作用機制及間接作用機制；臨床確診HCC主要采用血清學(xué)和影像學(xué)方法；HBV相關(guān)性HCC的抗病毒治療是最基本的病因治療。 回顧性分析結(jié)果示：納入6例慢性HBV感染者,其中慢性肝炎2例,肝硬化4例；HBeAg陰性5例；3例合并糖尿病;經(jīng)抗病毒治療后病毒載量均處于低度復(fù)制或不可測狀態(tài)。 結(jié)論：核苷類藥物聯(lián)合療法治療CHB能提高患者治療的有效性,且安全性較好；受限于納入研究的數(shù)量和質(zhì)量,上述結(jié)論尚需今后開展更多大樣本、高質(zhì)量的RCT加以驗證。在慢性HBV感染病程中監(jiān)測肝纖維化具有重要意義,而瞬時彈性成像是目前診斷肝纖維化的主要無創(chuàng)診斷方法。明確HBV相關(guān)性HCC發(fā)病機理、熟練掌握HCC的臨床診斷方法對其預(yù)防、早期發(fā)現(xiàn)及診療具有重要意義。經(jīng)抗病毒治療不能完全消除HCC發(fā)生的風(fēng)險,病毒載量、HBeAg陰性、糖尿病、肝硬化等可能是HCC發(fā)生的危險因素。
[Abstract]:Background : Chronic hepatitis B virus ( HBV ) infection is a worldwide epidemic , and our country is a major hepatitis B . At present , antiviral therapy is the key treatment and most effective treatment of chronic HBV infection . It can inhibit the replication of virus , promote the recovery of liver disease , reduce or delay the occurrence of complications and improve the quality of life of patients . In recent years , the most commonly used antiviral drugs are nucleoside medicaments . In recent years , the treatment of chronic HBV can lead to serious complications such as liver cirrhosis and hepatocellular carcinoma ( HCC ) .

Objective : To evaluate the efficacy and safety of tebivudine combined with adefovir in the treatment of chronic hepatitis B ( chronic hepatitis B ) , and provide a reference for clinical practice and research .
To investigate the significance of monitoring hepatic fibrosis in the course of chronic HBV infection and the latest development of transient elastography in the diagnosis of hepatic fibrosis ;
To investigate the main pathogenesis and clinical diagnosis and treatment of HCC caused by chronic HBV infection , and the therapeutic effect and influencing factors of chronic HBV infection in the prevention and treatment of HCC , and to make a certain contribution to prevention , early detection and diagnosis and treatment of HCC .

Methods : A systematic evaluation method was used to search for all relevant randomized controlled trials ( RCTs ) by computer . All the relevant randomized controlled trials ( RCTs ) were collected by computer . All the relevant randomized controlled trials ( RCTs ) were collected by two reviewers according to the study plan . After the quality evaluation of the literatures , the clinical data of 6 cases of chronic HBV infection related to liver fibrosis were analyzed retrospectively .

Results : 11 RCTs were included in the system evaluation , including 1010 patients . The test group was treated with tebivudine and adefovir divecuride . The results of Meta - analysis showed that the test group was superior to the single - dose tibivudine group or the single - agent adefovir difester group ( P0.05 ) .
The results of qualitative analysis showed that the drug resistance of the test group was the lowest , and the trial group did not increase the adverse drug reactions .

To monitor the liver fibrosis in patients with chronic HBV infection , assess and timely give the intervention measures to prevent the occurrence of complications such as liver cirrhosis effectively ;
Transient elastography is a new , rapid , non - invasive , economical and reproducible diagnostic technique for the diagnosis of liver fibrosis . The pathogenesis of HBV - induced HCC is very complex and is not yet fully elucidated , including the direct acting mechanism and the indirect action mechanism .
The clinical diagnosis of HCC mainly adopts serological and imaging methods .
The antiviral therapy of HBV - related HCC is the most basic cause of treatment .

The results of the retrospective analysis showed that 6 cases of chronic HBV infection were included , including 2 cases of chronic hepatitis and 4 cases of cirrhosis ;
HBeAg negative in 5 cases ;
3 cases with diabetes mellitus ; viral load after anti - viral treatment was in low - degree or non - measurable state .

Conclusion : The combination therapy of nucleoside drugs can improve the effectiveness and safety of the patients .
It is important to monitor liver fibrosis in the course of chronic HBV infection , and transient elastography is the main noninvasive method for diagnosis of liver fibrosis .

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62

【參考文獻】

相關(guān)期刊論文 前10條

1 陳念;柯柳;溫小鳳;蔣忠勝;蘇明華;韋靜彬;覃川;張鵬;;年輕慢性HBV攜帶者肝組織病理學(xué)分析[J];實用肝臟病雜志;2012年05期

2 黃斌;;聯(lián)合用藥治療耐藥型乙型肝炎的臨床療效[J];當(dāng)代醫(yī)學(xué);2013年03期

3 楊斌;占勁松;宋建新;;核苷類似物抗病毒治療后HBeAg(-)/(+)患者肝癌發(fā)生的臨床觀察[J];重慶醫(yī)學(xué);2013年12期

4 賀良;耿小平;趙紅川;趙義軍;張志功;劉付寶;王國斌;謝坤;;肝細胞肝癌中乙肝病毒基因整合位點及臨床病理分析[J];肝膽外科雜志;2013年02期

5 鄭聯(lián)Wu;魏開鵬;潘興南;魏梅娟;張小曼;王崇國;;血清高爾基體蛋白73診斷肝細胞癌價值探討[J];實用肝臟病雜志;2013年05期

6 王莉;何金娟;;原發(fā)性肝癌合并不同模式乙肝血清標(biāo)記物的臨床研究[J];安徽醫(yī)學(xué);2013年11期

7 楊麗潔;;HBV-x基因蛋白致肝癌的作用機制[J];價值工程;2011年12期

8 賈繼東;李蘭娟;;慢性乙型肝炎防治指南(2010年版)[J];臨床肝膽病雜志;2011年01期

9 葉菁菁;;慢性無癥狀乙型肝炎病毒攜帶者肝組織病理學(xué)特點以及與前C區(qū)變異關(guān)系[J];現(xiàn)代實用醫(yī)學(xué);2009年06期

10 楊永銳;李暉;高斯媛;沈凌;;替比夫定聯(lián)合阿德福韋酯治療HBeAg陽性慢乙肝臨床觀察[J];昆明醫(yī)科大學(xué)學(xué)報;2013年01期

，

本文編號：1692682