初始联合拉米夫定与阿德福韦酯在乙肝肝硬化治疗中的进展

慢性乙型肝炎在我国是一种常见疾病,每年约有2.0%~5.5%的患者进展为肝硬化,而一旦进入肝硬化失代偿阶段,治疗难度加大,生存率低。大量研究证实,早期有效的抗病毒治疗可以延缓肝硬化的进程,改善肝功能,延长生存期。目前抗病毒药物主要是干扰素和核苷(酸)类似物,但对于病毒载量相对较高的乙肝肝硬化患者,使用干扰素应答率低,单用一种核苷(酸)类似物疗效不稳定,耐药率高,进而导致抗病毒治疗失败。近年来大量临床研究表明,初始联合无交叉耐药的核苷(酸)类似物治疗乙肝肝硬化不仅能够快速抑制病毒复制,提高远期疗效,还能预防耐药的发生,为乙肝肝硬化的治疗提供了新的治疗方案。

Progress of initial combination therapy with lamivudine and adefovir dipivoxil for HBV-related cirrhosis

Chronic hepatitis B （CHB） is a kind of common diseases in China, each year about 2.0% - 5.5% of the CHB patients progress to liver cirrhosis, which make it more difficult to treat and survive. A large number of studies have confirmed early and effective antiviral treatment can slow down the process of liver cirrhosis, improve the liver func- tion and prolong the survival time. At present, antiviral drugs are mainly interferon and nucleos（t）ide analogues, but for HBV-related cirrhosis patients, the interferon shows low response rate, single kind of nucleos（t）ide analogues shows unstable curative effect and high resistance rate, which lead to antiviral treatment failure. In recent years, many clinical studies have indicated initial combination therapy with lamivudine and adefovir dipivoxil for HBV-related cirrhosis can not only inhibit viral replication rapidly and improve long-term curative effect, but also prevent the occurrence of drug resistance, which provide a new antiviral therapy for HBV-related cirrhosis.