摘要目的:探讨富马酸替诺福韦二吡呋酯对乙型肝炎肝硬化患者氧化应激及外周血Th17/Treg平衡的调节作用。方法:选取武装警察部队海警总队医院2020年3月至2021年6月诊治的乙型肝炎肝硬化患者102例为研究对象，按照随机数字表法分为观察组（予以富马酸替诺福韦二吡呋酯治疗）与对照组（予以恩替卡韦治疗）各51例，两组疗程42周。比较两组治疗前后丙二醛（MDA）、超氧化物歧化酶（SOD）、一氧化氮（NO）、辅助性T淋巴细胞17（Th17）、调节性T淋巴细胞（Treg）、Th17/Treg比值、透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）水平及HBV DNA转阴率、乙型肝炎病毒E抗原（HbeAg）转阴率、丙氨酸氨基转移酶（ALT）复常率、不良反应。结果:治疗前，两组SOD、MDA、NO、Th17、Treg、Th17/Treg比值、HA、LN、PCⅢ、Ⅳ-C差异均无统计学意义（均 P > 0.05）。治疗后，观察组SOD［（121.52±23.52）U/L］、Treg［（3.51±0.70）%］高于对照组［（113.30±20.05）U/L、（3.14±0.49）%］，而MDA［（7.40±1.35）mmol/L］、NO［（22.56±4.25）μmol/L］、Th17［（1.29±0.46）%］、Th17/Treg比值（0.45±0.11）、HA［（212.52±16.62）μg/L］、LN［（135.52±14.02）μg/L］、PCⅢ［（132.52±15.62）μg/L］、Ⅳ-C［（96.52±10.02）μg/L］均低于对照组，两组差异均有统计学意义（ t=1.90、-4.14、-6.81、4.02、3.10、-8.46、-13.27、-15.23、-13.67、-17.38，均 P < 0.05）。观察组的HBV DNA转阴率、HbeAg转阴率、ALT复常率分别为76.47%（39/51）、68.63%（35/51）、74.51%（38/51），均高于对照组的56.86%（29/51）、41.18%（21/51）、54.90%（28/51）（χ 2=4.41、7.76、4.29，均 P < 0.05）。两组不良反应发生率差异无统计学意义（ P > 0.05）。 结论:富马酸替诺福韦二吡呋酯治疗乙型肝炎肝硬化效果较好，有利于减轻患者氧化应激和调节外周血Th17/Treg平衡。

abstractsObjective:To investigate the regulatory effects of tenofovir disoproxil fumarate on oxidative stress and peripheral blood Th17/Treg balance in patients with hepatitis B cirrhosis.Methods:A total of 102 patients with hepatitis B cirrhosis who received treatment in the Marine Police Corps Hospital of Chinese People's Armed Police, China from March 2020 to June 2021 were included in this study. They were randomly assigned to undergo treatment with either tenofovir disoproxil fumarate ( n = 51, observation group) or entecavir ( n = 51, control group) for 42 weeks. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), T helper 17 cells (Th17), regulatory T cells (Treg), Th17/Treg ratio, hyaluronic acid (HA), laminin (LN), type III procollagen (PC III), type IV collagen (IV-C), hepatitis B virus DNA negative rate, HBeAg negative rate, and alanine aminotransferase normalization rate pre- and post-treatment as well as the incidence of adverse reactions were compared between the two groups. Results:Before treatment, there were no significant differences in SOD, MDA, NO, Th17, Treg, Th17/Treg ratio, HA, LN, PC III, IV-C between the two groups (all P > 0.05). After treatment, SOD and Treg in the observation group were (121.52 ± 23.52) U/L and (3.51 ± 0.70)% in the observation group, respectively, which were significantly higher than (113.30 ± 20.05) U/L and (3.14 ± 0.49)%, respectively in the control group ( t = 1.90, -4.14, both P < 0.05). MDA, NO and Th17, Th17/Treg ratio, HA, LN, PC III, and IV-C in the observation group were (7.40 ± 1.35) mmol/L, (22.56 ± 4.25) μmol/L, (1.29 ± 0.46)%, (0.45 ± 0.11), (212.52 ± 16.62) μg/L, (135.52 ± 14.02) μg/L, (132.52 ± 15.62) μg/L,(96.52 ± 10.02) μg/L, respectively, which were significantly lower compared with the control group ( t = -6.81, 4.02, 3.10, -8.46, -13.27, -15.23, -13.67, -17.38, all P < 0.05). Hepatitis B virus DNA negative rate, HBeAg negative rate, and alanine aminotransferase normalization rate in the observation group were 76.47% (39/51), 68.63% (35/51) and 74.51% (38/51), respectively, which were higher than 56.86% (29/51), 41.18% (21/51), 54.90% (28/51) in the control group ( χ2 = 4.41, 7.76, 4.29, all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Tenofovir disoproxil fumarate is highly effective on hepatitis B cirrhosis. It can reduce oxidative stress and regulate peripheral blood Th17/Treg balance.