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1、慢性乙型肝炎使用卡托普利联合拉米夫定治疗的抗肝纤维化疗效分析李春明，吴玉华，史正全，孙其妹，王沙莉（镇江市第三人民医院肝炎科，镇江212003）摘要：目的：研究联合使用抗病毒药物和血管紧张素转换酶抑制剂治疗慢性乙型肝炎的抗肝纤维化疗效，探索具有显著疗效的治疗方案。方法：回顾性队列分析护肝降酶治疗、拉米夫定抗病毒、卡托普利降血压治疗及联合使用拉米夫定、卡托普利治疗至少一年的慢性乙型肝炎患者共166例的临床资料，比较使用不同治疗方案患者治疗前后肝纤维化血清标志物变化情况。结果：配对T检验显示使用不同治疗方案的各组患者治疗前后肝纤维化血清标志
2、物（肝纤4项）水平差异均有统计学意义。Ridit分析显示各治疗组抗肝纤维化疗效由高到低依次是联合用药组、拉米夫定组、卡托普利组、护肝治疗组；联合用药组与护肝治疗组、拉米夫定组、卡托普利组之间疗效差异均有统计学意义（P分别为0.000,0.003,0.032）,拉米夫定组与单纯护肝组之间疗效差异也有统计学意义（方0.029）,但卡托普利组与拉米夫定组、护肝治疗组之间疗效差异均无统计学意义（P分别为0.984,0.205）。结论：护肝治疗、拉米夫定抗病毒、使用卡托普利治疗及联合拉米夫定与卡托普利等治疗方案均有抗肝纤维化疗效，但疗效存在差异，
3、联合用药组疗效最佳，其次拉米夫定组、再次卡托普利组，护肝治疗组疗效较差。关键词：慢性乙型肝炎；肝纤维化；拉米夫定；卡托普利Analysisofanti-fibrosiseffectofcombinationtreatmentwithlamivudineandcaptoprilonpatientswithchronichepatictisBLIChun-ming,WUYuhua,SHIZheng-quan,SUNQi-mei,WANGSha-liAbstract:ObjectsTostudyanti-fibrosiseffectofcom
4、binationtreatmentwithlamivudineandcaptopri1onpatientswithCHB（chronichepatitisB）andexploretherapystrategywithpotentanti-fibrosiseffect.Methodsanalyzedbyretrospectivecohortstudyclinicaldataoftota1166casesofCUBpatientswhomweredividedintoprotecting1ivergroup,lamivudinetreatm
5、entgroup,captopriltreatmentgroupandcombinationtreatmentgroupwithlamivudineandcaptopri1accordingtodifferenttherapystrategyusedonthemandcomparedchangeofserumfibrosismarkersofCHBpatientsbeforeandaftertreatmentResultsThedifferenceof1iverserumfibrosismarkersbeforeandaftertrea
6、tmentwereal1siginificantamonga11treatmentgroups.Riditanalysisshowedthatorderofanti-fibrosiseffectofdifferenttherapygroupwascombinationtreatmentgroup,lamivudinegroup,captopri1group,protecting1ivergroupsuccessivelywhenarrangedfromhightolow.thedifferenceofanti-fibrosiseffec
7、twasa11significantbetweencombinationtreatmentgroupandlamivudinegroup,captopri1group,protecting1ivergroup（P=0・000,0.003,0.032,respectively）;thedifferenceofanti-fibrosiseffectwasalsosignificantbetweenlamivudinegroupandprotecting1ivergroup（T^O.029）;buttherewerenosignificant
8、differencebetweencaptopri1groupandlamivudinegroup,protecting1ivergroup（/M.984,0・205,respectively）.Concl
