恩替卡韦与拉米夫定治疗乙肝病毒所致慢加急性肝功能衰竭疗效的对比研究

目的比较恩替卡韦和拉米夫定治疗乙肝病毒（HBV）所致慢加急性肝功能衰竭（subacute—on．chronicliverfailure．SCLF）的疗效。方法93例HBV所致慢加急性肝功能衰竭患者随机分为恩替卡韦组（46例）和拉米夫定组（47例）两组。两组患者均在常规内科治疗基础上加用恩替卡韦或拉米夫定，疗程48周。观察用药后两组患者血清生化指标、HBVDNA转阴率、存活率及病毒反跳情况。结果治疗4周和12周时恩替卡韦组的A¨值分别为（49．9±31．4）U／L和（33．2±20．5）U／L，明显低于拉米夫定组的（88．6±58．2）U／L和（55.4±31．7）U／L，两组比较差异具有统计学意义（P〈0．05）。其他生化指标两组比较差异无统计学意义。恩替卡韦治疗后4周及48周时HBVDNA转阴率分别为71．7％及97．8％，显著高于拉米夫定组的51．1％和72．3％，差异具有统计学意义（P〈0．05）。治疗48周内恩替卡韦组的存活率为80．4％，高于拉米夫定组的61．7％。恩替卡韦组46例患者无1例发生病毒反跳，而拉米夫定组47例患者中有5例发生病毒反跳。结论恩替卡韦治疗慢加急性肝功能衰竭的抗病毒效果及患者存活率均高于拉米夫定．且不容易发生病毒反跳，因此适合慢加急性肝功能衰竭的长期治疗。

A Comparison of Entecavir and Lamivudine for Subacute-on-chronic Liver Failure Infected with HBV

Objective To compare the effects of Entecavir and Lamivudine on patients with subacute-onchronic liver failure infected with hepatitis B virus （HBV）. Methods 93 patients with no prior history of antiviral therapy were divided randomly into two groups：Entecavir group （46 cases）, and Lamivudine group （47 cases）. The dosage in the Entecavir group and Lamivudine group was 0.5 mg/d and 100 mg/d, respectively, and the duration of therapy was 48 weeks. The effects of Entecavir and Lamivudin on TBiL, ALT, ALB, PTA, HBV DNA, survival rate and virologic rebound were observed during the treatment. Results The ALT levels in Entecavir group were significantly higher than the Lamivudine group at 4 and 12 weeks, and the other indexs had no significant difference. The HBV DNA negative conversion rate in the Entecavir group was higher than that in Lamivudine group, which was 71.7% versus 51.1% on week 4, and 97.8% versus 72.3% on week 48 after treatment. The survival rate in Enteeavir group （80.4%） was higher than that in Lamivudine group （61.7%）. No viral resistance was observed in Entecavir group, but 5 patients in Lamivudine group had virological rebound during 48 weeks. Conclusion Entccavir is more effective in inhibiting reproduction of HBV than that of Lamivudine, and there is no evidence of viral resistance to entecavir. So Entecavir could be used for long-term treatment of the patients with subacute on chronic liver failure.