e抗原阴性乙型肝炎失代偿期肝硬化患者初始拉米夫定联合阿德福韦酯治疗的疗效观察

目的观察初始拉米夫定（LAM）联合阿德福韦酯（ADV）对e抗原阴性乙型肝炎失代偿期肝硬化的治疗效果。方法选择2011年1月-2013年1月南阳市中心医院感染科收治的e抗原阴性乙型肝炎失代偿期肝硬化患者共200例，随机分为联合治疗组（LAM＋ADV组）80例、单药治疗组共120例：其中拉米夫定单药组（LAM组）60例、阿德福韦酯单药组（ADV组）60例。抗乙肝病毒药物按照常规剂量口服（LAM100mg／d、ADV10mg／d）。各组的保肝治疗方案相同。比较各组患者在治疗前及治疗后12，24，48周血清HBVDNA水平；治疗前及治疗后2，4，6，8周肝功能转归以及Child-Pugh评估。结果LAM＋ADV组与LAM组和ADV组比较：在治疗48周时HBVDNA阴转率分别为97．5％、83．3％和80％，联合治疗组与各单药组差异均有统计学意义（P〈0．05）；在治疗8周时Child—Pugh计分分别为6．8±1．0、7．1±1．3和7．3±1．2，联合治疗组与各单药组差异均有统计学意义（P〈0．05）；肝功能恢复速度LAM＋ADV组较LAM组和ADV组快，（LAM＋ADV组6周，LAM组和ADV组均8周）。在治疗8周时肝功能无差异。结论对e抗原阴性乙型肝炎失代偿期肝硬化，初始拉米夫定联合阿德福韦酯的治疗效果优于单用拉米夫定或阿德福韦酯治疗效果。

CLINICAL EFFICACY OF LAMIVUDINE COMBINED WITH ADEFOVIR IN TREATMENT OF PATIENTS WITH HBEAG NEGATIVE CHRONIC HEPATITIS B

Objective To evaluate the clinical efficacy of lamivudine（LAM） combined with adefovir（ADV） in treatment of patients with HBeAg negative chronic hepatitis B. Methods A retrospective analysis of Nanyang central hospital from January 2009 to January 2013 admitted to hospital was performed, totally 200 patients with HBeAg negative chronic hepatitis B were randomly divided into combined treatment group （LAM ＋ ADV） of 80 cases, LAM group of 60 eases and ADV group of 60 cases. The patients were treated with LAM 100mg/d and ADV dipivoxil 10mg/d on the basis of comprehensive treatments, the course was 48 weeks. The clinical symptoms, serum HBV DNA level before and 12, 24, 48 weeks after the therapy were compared and the biochemical indicator, Child- Pugh degree scores before and 2, 4, 6, 8 weeks after the therapy were compared. Results By week 48, the negative rate of HBV DNA in LAM＋ ADV, LAM and ADV treatment group were 97.5 %, 83.3 % and 80 % respectively, which in LAM ＋ ADV had statistically significant to LAM or ADV group （P〈0.05） . And by week 8, the Child- Pugh scores were 6. 8±1.0, 7.1 ±1.3 and 7.3 ±1.2 respectively, which in LAM ＋ ADV had statistically significant to LAM or ADV group （P〈0.05）. The speed of liver function recovery of LAM ＋ ADV in 6 weeks was higher than which of LAM and ADV. However, by week 8 there was no significant difference in liver fuction between every tow groups. Conclusion Combination lamivudine and adefovir in treatment of HBeAg negative chronic hepatitis B has an advantage over lamivudine or adefovir treatment alone.