乙型肝炎肝硬化失代偿期初始拉米夫定和阿德福韦酯联合抗病毒治疗的疗效观察

目的研究拉米夫定（LAM）初始联合阿德福韦酯（ADV）治疗乙型肝炎肝硬化失代偿期患者的疗效与安全性。方法30例HBeAg阳性乙型肝炎肝硬化失代偿期患者，分为LAM初始联合ADV治疗组和变异后联合组，疗程均为48周。结果初始联合组与变异后联合组患者ALT与TBil在治疗4、12、24与48周均较基线明显好转（P〈0．05），治疗4、12周后，两组均无HBVDNA转阴的患者，治疗24周后，分别有4例（40％）初始联合组与4例（20％）变异后联合组患者HBVDNA转阴，但差异无统计学意义。治疗48周后，初始联合组与变异后联合组HBVDNA转阴率分别为90％（9／10）与40％（8／20），HBeAg／抗-HBe血清转换率分别为60％（6／10）与20％（4／20），两组间差异均具有统计学意义（P〈0．05）。初始联合组患者Child—Pugh评分在48周时，优于变异后联合组（P〈0．05）。结论ADV初始联合LAM治疗在改善乙型肝炎肝硬化失代偿期患者临床状况及抗病毒方面均明显优于变异后联合治疗。

The evaluation of de novo combination of antiviral treatment to hepatitis B patients with decompensated cirrhosis

Objective To evaluate the efficacy and safety of de novo combination therapy with lamivudine and adefovir dipivoxil in the treatment patients of chronic hepatitis B with decompensated cirrhosis.Methods Thirty chronic hepatitis B patients with decompensated cirrhosis were enrolled in and divided into two groups,one group(10 patients) was given lamivudine combined with adefovir dipivoxil at the beginning of the therapy,while the other group(control group) was given lamivudine only at the beginning of treatmen...