拉米夫定治疗失代偿期乙肝肝硬化的临床研究

目的观察拉米夫定对失代偿期乙肝肝硬化患者的治疗效果和安全性。方法60例患者Child-Pugh评分、基础情况相当，分为治疗组和对照组各30例，治疗组在常规治疗同时服用拉米夫定，每日100mg，对照组给予常规治疗。结果拉米夫定治疗随访时间中位数为2年2月。所有患者治疗3～6月后症状和体征逐渐改善，腹水消失。拉米夫定治疗组1年内血清HBV-DNA转阴率76．67％（23／30），血清白蛋白和PTA上升、总胆红素均有下降，Child-Pugh评分减少，2年生存率达93．33％，并发症及再次住院率明显下降。拉米夫定治疗出现YMDD变异率：1年为6．67％（2／30），2年为33．33％（10／30），出现病毒变异后及时加用阿德福韦酯的患者肝功能恢复良好。结论拉米夫定治疗能改善失代偿期乙肝肝硬化肝功能和提高生存率。一旦出现YMDD变异，及时加用阿德福韦酯等针对YMDD变异的抗病毒药物可抑制变异的HBV的复制，防止肝功能恶化。

Lamivudine treatment in patients with decompensated cirrhosis due to hepatitis B

Objective To evaluate the efficacy and safety of lamivudine in treating for decompensated cirrhosis due to chronic hepatitis B. Methods Sixty patients with decompensated cirrhosis of hepatitis B virus infection were randomly divided treatment group （30 cases） and control group （30 cases）, which were matched for age , gender, liver function and Child-Pugh score. Treatment group were treated with lamivudine 100 mg orally once daily. Supportive treatment and symptomatic treatment were given in two groups. Results The median follow-up was 26 months in the patients of treatment group. Symptoms of all patients were relieved gradually after 3 to 6 months. Ascites disappeared in all patients. The rates of negative conversion for the serum HBV-DNA were 76.67% （23/30） in the patients of treatment group after 1 year of lamivudine therapy. There was a significant improvement in clinical symptoms and liver function,with an increase in serum albumin and PTA, and a decrease in total serum bilirubin and Child-Pugh score. Two year survival rate was 93.33%. The complication rate and the re-admission rate were also markedly reduced. The rates of YMDD mutation treated groups were 6.7% （2/30） and 33.3 % （10/30） in 1 year and 2 years respectively. Obvious clinical improvement was observed following the prompt addition of adefovir dipivoxil to lamivudine in decompensated patients with YMDD variant HBV. Conclusion Lamivudine therapy can result in a significant improvement of liver function and the prolonging of survival time in patients with decompensated HBV cirrhosis. The prompt addition of newer antiviral agents such as adefovir dipivoxil with activity against the YMDD mutants to lamivudine can effectively inhibit mutated HBV replication and prevent the acute exacerbation of liver function once the YMDD mutant emerges.