恩替卡韦初治代偿期和失代偿期乙肝肝硬变患者 96 周疗效比较

目的：比较代偿期和失代偿期乙肝肝硬变患者接受恩替卡韦（ETV）初始抗病毒治疗疗效。方法：回顾性分析初始应用ETV治疗96周的代偿期（n=54）和失代偿期（n=51）肝硬变患者，比较两组治疗前后不同时间点肝功能、HBVDNA阴转率、Child—Puge评分、食管静脉曲张程度、肝硬度的变化和区别及临床结局的情况。结果：代偿期组12周和24周时血清丙氨酸转氨酶（ALT）复常率明显高于失代偿期组（P〈0．01），12周HBVDNA阴转率明显高于失代偿期组（P〈0．05）。代偿期和失代偿期组血清白蛋白分别于12周、24周开始明显高于基线（P〈0．01），胆碱酯酶（CHE）分别于24周、48周开始明显高于基线（P〈0．01）。96周时，100％代偿期和96．1％失代偿期组Child—Pugh评分表现为改善和稳定；11例代偿期和4例失代偿期患者食管静脉曲张有不同程度减轻；两组患者肝硬度均减低，代偿期组减低更明显，治疗后与基线比较差异有统计学意义（P〈0．01）。结论：经长期ETV抗病毒治疗，代偿期肝硬变患者可获得更显著的疗效。

Comparison of entecavir efficacy in initial treatment for HBV patients with compensated and decompensated cirrhosis in 96 weeks

Objective： To compare the efficacy ofentecavir （ETV）in initial treatment for HBV patients with compensated and decompensated cirrhosis in 96 weeks. Methods： Data of 54 compensated and 51 decompensated cirrhotic patients treated with ETV（〉96 weeks） were collected, and the difference of liver function, HBV DNA negativity, Child-Puge score, the degree of esophageal varix and liver stiffness value were compared before and after treatment between the groups. Results： Alanine aminotransferase normalized rate was significantly higher at 12 and 24 weeks（P〈O.01） and HBV DNA negativity rate was higher at 12 weeks（P〈0.05） in the compensated group than in the decompensated group. In the two groups, serum albumin levels were much higher than the baseline at 12 and 24 weeks, respectively （P〈0.01）, and serum cholinesterase levels were significantly higher than the baseline at 24 and 48 weeks, respectively （P〈0.01）. The Child-Pugh score improved or remained steady in all compensated patients and 96.1% of decompensated patients. The degree of esophageal varix was lessened for 11 compensated and 4 decompensated patients. Liver stiffness value was significantly decreased in the compensated group compared with the baseline （P〈0.01）. Conclusion： Long-term ETV treatment has superior effect on the compensated cirrhotic patients.