目的 探讨腺苷蛋氨酸联合恩替卡韦对胆汁淤积型乙型病毒性肝炎（乙肝）的预后影响。方法 选择2016年9月— 2019年2月在开封市中心医院收治的胆汁淤积型乙肝患者172例。根据治疗方法的不同将患者分为对照组（72例）和观察组（100例）。对照组口服恩替卡韦分散片，0.5 mg/d。观察组在对照组治疗的基础上使用注射用丁二磺酸腺苷蛋氨酸，1 g/d。两组均治疗观察8周。观察两组患者的临床疗效，同时比较两组患者的肝功能指标、乙肝病毒的脱氧核糖核酸（HBVDNA）阴转情况和不良反应发生情况。结果 治疗后，观察组的总有效率为97.0%，显著高于对照组的80.6%（P<0.05）。两组治疗后的血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）水平均显著低于治疗前（P<0.05），且观察组各肝功能指标水平显著低于对照组（P<0.05）。治疗后，观察组的HBV-DNA转阴率为99.0%，显著高于对照组的90.3%（P<0.05）。两组治疗期间的不良反应发生率比较差异无统计学意义。结论 腺苷蛋氨酸联合恩替卡韦治疗胆汁淤积型乙肝能提高HBV-DNA转阴率与治疗效果，促进患者肝功能的改善，且不会增加不良反应，具有一定的临床推广应用价值。

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

河南省医学科技攻关计划项目（201701027）