安络化纤丸治疗慢性乙型肝炎肝纤维化的疗效观察

目的观察安络化纤丸对慢性乙型肝炎患者血清肝纤维化指标的影响。方法慢性乙型肝炎患者62例随机分为治疗和组对照组,治疗组32例,对照组30例,治疗组给予安络化纤丸口服,6g,3次/d;对照组给予复方丹参片口服,4片,3次/d;疗程均为为3个月,观察两组治疗前后血清肝纤维化指标。结果治疗后2组肝纤维化指标均有改善,但治疗组恢复程度明显优于对照组(P<0.05)。结论安络化纤丸能改善慢性乙型肝炎患者的肝纤维化指标。     

复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化的疗效观察

目的观察慢性乙型肝炎血清纤维化指标升高、B超异常患者应用复方鳖甲软肝片治疗后的疗效。方法将慢性乙型肝炎患者53例,分为治疗组27例,对照组26例。治疗组每次给予复方鳖甲软肝片4片,每日三次;对照组给予大黄癀虫丸3克,每日二次。疗程均为6个月。结果两组均有抗肝纤维化作用,但复方鳖甲软肝片在改善HA、PⅢP、B超方面明显优于对照组,具有显著差异。结论复方鳖甲软肝片抗肝纤维化功效显著。     

软肝缩脾胶囊治疗慢性乙型肝炎肝纤维化150例

目的：探索软肝缩脾胶囊活疗慢性乙型肝炎的疗效。方法：以本院制剂室鳖甲、丹参等15味中药制成的软肝缩脾胶囊口服4个月为一疗程后，进行疗效对比。结果：以此中药治疗后总有效率为87．33％，患的临床表现、肝功变化、肝纤维化测定指标都有明显改善。结论：软肝缩脾胶囊对慢性乙型肝炎肝纤维化能起到较好的抗肝纤维化作用，疗效明显高于对照组。     

消症软肝胶囊治疗肝炎肝纤维化120例疗效观察

目的 以鳖甲煎丸作为对照组,观察自制中成药消症软肝胶囊治疗乙型肝炎肝纤维化的临床疗效和毒副作用.方法 选择120例乙型肝炎肝纤维化患者,随机分为两组:观察组和对照组,观察组服用消症软肝胶囊,对照组服用鳖甲煎丸,随访24周.治疗前、治疗中、治疗后查肝功能,肝纤指标,B超,血常规,肾功能,心电图.同时观察患者临床症状变化情况,并对结果进行统计学处理判定疗效.结果 ①治疗24周和随访24周时,治疗组临床症状好转率,肝功能及肝纤维化指标复常率均高于对照组.②两组总的不良事件发生率、药物相关的不良事件种类及各自的发生率差异无统计学意义.结论 消症软肝胶囊治疗乙型肝炎肝纤维化疗效优于鳖甲煎丸,且无明显毒副作用,有待进一步探讨.     

阿德福韦酯联合干扰素与软肝冲剂治疗慢性乙型肝炎肝纤维化

目的探讨慢性乙型肝炎纤维化的治疗方法。方法 2003年9月—2009年10月收治慢性乙型肝炎肝纤维化患者66例,采用阿德福韦酯、干扰素、软肝冲剂联合应用,观察肝功能、血清肝纤维化指标。结果治疗后肝功能ALT、AST、TbiL、Aib均较治疗前有明显改善（P〈0.05）;血清肝纤维化指标HA、Pcn、CIViC、LM、TNFa也均有明显改善（P〈0.05）。结论阿德福韦酯联合干扰素、软肝冲剂治疗慢性乙型肝炎、肝纤维化疗效满意。     

活血软肝汤联合恩替卡韦对慢性乙型肝炎肝纤维化指标和病理组织的影响

目的观察活血软肝汤联合恩替卡韦对慢性乙型肝炎肝纤维化指标和肝脏病理组织的影响。方法治疗组采用恩替卡韦0.5mg,1次/d,口服,加用活血软肝汤,一次200ml,2次/d,口服;对照组采用恩替卡韦0.5mg,1次/d,口服,不服用其他抗纤维化及调解免疫药物;疗程均为12个月。结果两组治疗后临床症状、体征改善情况比较有统计学意义;治疗组治疗前、后HA、PCIII、LN,有统计学意义(t=2.65,P<0.05),两组治疗后的HA、PCIII、IN比较,有统计学意义(t=2.16,P<0.05),两组治疗前后门静脉内径、脾静脉内径和脾脏厚度比较,有统计学意义;治疗后在坏死炎症、小叶内炎症、门静脉炎症和纤维化等治疗组明显优于对照组。结论两药合用治疗慢性乙型肝炎12个月,血清肝纤维化指标和病理组织均有明显改善,值得临床推广应用。     

复方桃仁软肝胶囊联合拉米夫定治疗慢性乙型肝炎肝纤维化的临床观察

目的:观察复方桃仁软肝胶囊联合拉米夫定抗乙型肝炎肝纤维化的疗效。方法:60例慢性乙型肝炎肝纤维化患者被随机分为复方桃仁软肝胶囊联合拉米夫定(治疗组)和单用拉米夫丁(对照组),疗程为9mo。观察治疗前后两组患者血清肝纤维化指标:透明质酸酶(HA)、IV型胶原(IV-C)和层粘蛋白(LN)的变化。结果:治疗组治疗后血清肝纤维各项指标均显著改善,与对照组比较有统计学差异(P<0.01或P<0.05)。结论:复方桃仁软肝胶囊联合拉米夫定可能具有抗乙型肝炎肝纤维化的功效,可在临床进一步验证。     

复方鳖甲软肝片联合还原型谷胱甘肽治疗代偿期乙型肝炎后肝硬化的临床观察

目的:观察复方鳖甲软肝片联合还原型谷胱甘肽治疗代偿期乙型肝炎后肝硬化的临床疗效和安全性。方法:采用随机数字表法将64例代偿期乙型肝炎后肝硬化患者均分为对照组和观察组。两组均予以对症支持治疗,对照组患者在支持治疗的基础上给予还原型谷胱甘肽400 mg,口服,3次/d;观察组患者在对照组治疗的基础上加用复方鳖甲软肝片4片,口服,3次/d。两组患者均治疗12周。比较两组患者总有效率及治疗前后乙型肝炎病毒DNA(HBV-DNA)拷贝数、肝功能指标、肝纤维化指标和肝脾B超图像变化,并观察治疗过程中的不良反应发生情况。结果:治疗后,观察组患者总有效率显著高于对照组(P<0.05);两组患者的HBV-DNA拷贝数、肝功能指标、肝纤维化指标、脾脏厚度、脾静脉及门静脉内径均较治疗前显著改善(P<0.05或P<0.01),且观察组患者肝功能指标、肝纤维化指标、脾脏厚度、脾静脉及门静脉内径的改善情况均显著优于对照组(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:复方鳖甲软肝片联合还原型谷胱甘肽治疗代偿期乙型肝炎后肝硬化可有效改善患者的肝功能及肝纤维化程度,延缓肝硬化的发展,疗效优于单用还原型谷胱甘肽,且安全性较好。     

心肝宝胶囊抗肝纤维化的临床观察

目的观察心肝宝胶囊对慢性乙型肝炎患者血清肝纤维化指标的临床治疗效果。方法将90例慢性乙型肝炎患者随机分为治疗组和对照组,观察治疗结束后两组血清肝纤维化指标的变化。结果在治疗组血清肝纤维化指标明显改善,与对照组相比有显著性差异。结论心肝宝胶囊有减轻肝损伤促使血清ALT复常的作用。尤其是可以降低血清肝纤维化指标水平,可以达到减轻和抑制肝纤维化形成的作用,值得临床应用。     

阿德福韦酯与复方鳖甲软肝片联合治疗慢性乙型肝炎效果观察

目的探讨单独使用阿德福韦酯,与阿德福韦酯联合复方鳖甲软肝片治疗慢性乙型肝炎及对肝纤维化影响的临床疗效。方法 52例单用阿德福韦酯治疗的患者作为对照组,55例使用阿德福韦酯与复方鳖甲软肝片联合治疗慢性乙型肝炎的患者作为实验组。两组患者在治疗前及治疗后每2个月抽血清标本检查肝功能,HBsAg、HBeAg、HBV-DNA以及血清肝纤维化指标。结果服药治疗后,治疗组患者的肝功能好转率、HBsAg、HBeAg、HBV-DNA转阴率、血清肝纤维化指标,实验组和对照组患者比较,差异有统计学意义。结论阿德福韦酯与复方鳖甲软肝片联合治疗慢性乙型肝炎及肝纤维化的疗效优于单用阿德福韦酯治疗的疗效。     

拉米夫定治疗失代偿肝炎后肝硬化的临床研究

目的观察拉米夫定治疗失代偿肝炎后肝硬化患者的临床疗效和安全性。方法31例失代偿肝炎后肝硬化患者,随机分组:治疗组16例拉米夫定治疗24~54月(平均33月),对照组15例常规治疗24~52月(平均32月),观察临床表现、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(Ab)和总胆红素(Tb il)、凝血酶原时间(PT)、HBV-DNA(荧光定量PCR法)、B超以及ch ild-pugh积分的变化。结果治疗组除2例因并发症死亡,其余14例临床表现明显改善,肝功能明显好转,HBV-DNA均小于1000拷贝/毫升,ch ild-pugh积分降低(均P<0.01)。而对照组除6例因并发症死亡,其余9例无显著改变。所有患者治疗中均无明显毒副反应发生。结论长期拉米夫定治疗失代偿肝炎后肝硬化,能快速有效抑制HBVD-NA,阻止肝细胞损伤,改善肝功能和生活质量,是一种安全,有效的治疗方法。     

拉米夫定联合阿德福韦酯治疗乙肝肝硬化的效果研究

目的研究恩替卡韦与拉米夫定联合阿德福韦酯治疗慢性乙型病毒性肝炎(乙肝)肝硬化患者的临床效果。方法 86例乙肝肝硬化患者为研究对象,随机分为观察组(42例)和对照组(44例)。两组患者均采用保肝、利尿及间断输注白蛋白等基本常规治疗,在此基础上对照组患者采用恩替卡韦治疗,观察组采用拉米夫定联合阿德福韦酯治疗。观察比较两组患者治疗前后的肝功能指标[血清白蛋白/球蛋白比值(A/G)、谷丙转氨酶(ALT)、总胆红素(TBIL)]。结果治疗前,两组患者A/G、ALT、TBIL水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者A/G(1.71±0.56)高于对照组的(1.21±0.46),ALT(30.52±4.24)U/L、TBIL(90±22)μmol/L均低于对照组的(76.78±9.24)U/L、(122±28)μmol/L,差异有统计学意义(P<0.05)。结论恩替卡韦与拉米夫定联合阿德福韦酯治疗方案均可很好改善乙肝肝硬化患者的肝功能,而阿德福韦酯联合拉米夫定治疗方案改善乙肝肝硬化患者肝功能效果更好,并且联合用药较单一用药可降低耐药性,值得临床推广。     

Cost-effectiveness analysis of lamivudine for the treatment of chronic hepatitis B

OBJECTIVE: To estimate the short term and long term cost effectiveness, from a healthcare perspective, associated with the introduction of lamivudine for chronic hepatitis B. DESIGN: The analysis used a 2-step modelling approach. A decision tree was used to estimate clinical outcomes and costs after 1 year. The 1-year results were then extrapolated to 70 years using a Markov model. PATIENTS: The study population comprised hypothetical cohorts of patients with chronic hepatitis B, representative of those likely to receive treatment in clinical practice in Australia. MAIN OUTCOME MEASURES AND RESULTS: In the short term, more patients sero-converted when lamivudine was available, with an incremental cost-effectiveness ratio of 3341 Australian dollars ($A) per additional seroconversion. In the long term, the introduction of lamivudine increased life expectancy by 3.9 years [3.2 quality-adjusted life-years (QALYs)] compared with when interferon-alpha was the only treatment, or 4.6 years (3.8 QALYs) compared with no treatment. There were reductions in lifetime risk of developing compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma of 5, 11 and 11%, respectively, when lamivudine was available. The incremental cost of having lamivudine available, as opposed to interferon-alpha only, was $A633 per year of life saved or $A735 per QALY. CONCLUSION: The introduction of lamivudine is expected to reduce and delay the progression of chronic hepatitis B, increasing the life expectancy and quality of life of patients for a small overall increase in healthcare costs.     

阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化的效果评价

目的探讨阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化的临床效果。方法将本院收治的138例乙型肝炎肝硬化患者随机分为两组,各69例。对照组采用常规保肝、纠正水电解平衡及排腹水等常规治疗,观察组在常规治疗基础上采用阿德福韦酯联合拉米夫定治疗。结果治疗后,观察组Child-Pugh评分、ALT、ALB、TBi L水平低于对照组,差异有统计学意义（P〈0.05）。结论阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化能有效终止HBV-DNA在体内复制,降低血清病毒含量,促进肝脏TBi L代谢,改善肝功能。     

拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化48例临床疗效观察

目的探究拉米夫定（LAM）联合阿德福韦酯（ADV）治疗乙型肝炎肝硬化的临床疗效。方法将2008年3月-2013年2月来我院就诊的48例乙型肝炎肝硬化患者根据治疗方法不同分为观察组和对照组,其中观察组24例,给予拉米夫定联合阿德福韦酯治疗,对照组24例,给予拉米夫定治疗,观察并比较治疗前后血清乙型肝炎病毒（HBV）DNA水平及主要肝功能指标变化情况。结果两组患者治疗12个月后血清HBVDNA水平及肝功能均有改善,观察组改善较为明显,差异有统计学意义（P〈0．05）,观察组治疗12个月后血清HBVDNA转阴率相比对照组有统计学差异（P〈0．01）。结论拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化疗效较好,肝功能改善明显,值得在临床上予以推广。     

Lamivudine monotherapy in HBeAg-negative chronic hepatitis B: prediction of response-breakthrough and long-term clinical outcome

BACKGROUND: Factors that predict response and breakthrough phenomenon to lamivudine monotherapy in patients with HBeAg-negative chronic hepatitis B have not been well defined. AIM: To determine pre-treatment and on treatment variables that predict initial response and breakthrough in patients with HBeAg-negative chronic hepatitis B receiving long-term lamivudine. METHODS: Seventy-nine patients, with chronic HBeAg-negative hepatitis B, who received lamivudine for a median of 31 months were included in the study. RESULTS: Initial virologic and biochemical response was observed in 73 (92%) and 70 (89%) patients, respectively, while 34 (47%) and 15 (21%) patients developed virological and biochemical breakthrough, respectively. High levels of necroinflammation in liver biopsy were associated with a higher probability of initial virological and biochemical response. Patients with pre-treatment serum hepatitis B virus DNA concentrations of more than 10(6) copies/mL were three times more likely to develop virologic breakthrough. Two patients died, one with baseline cirrhosis because of liver failure during biochemical breakthrough while the second death was liver and treatment unrelated. CONCLUSIONS: In HBeAg-negative chronic hepatitis B, initial response to lamivudine therapy is associated with necroinflammation, while baseline serum hepatitis B virus DNA exceeding 10(6) copies/mL is a strong predictor for breakthrough because of drug-resistant mutations. Severe complications are uncommon and are associated with biochemical breakthrough and pre-existing cirrhosis.     

拉米夫定联合阿德福韦酯治疗活动性乙型肝炎肝硬化的效果观察

目的 探讨拉米夫定联合阿德福韦酯治疗活动性乙型肝炎肝硬化的长期效果.方法 选取本院2010年1～12月收治的116例活动性乙型肝炎肝硬化患者,按照随机原则分为研究组与对照组,研究组采用拉米夫定联合阿德福韦酯治疗,对照组采用拉米夫定治疗,分析和比较两组的治疗效果、肝功能相关指标、HBV-DNA转阴率.结果 研究组的总有效率明显高于对照组,差异有统计学意义（P＜0.05）.两组治疗后的HA、Ⅳ-C 、TBiL、ALT均低于治疗前,ALB高于治疗前,差异有统计学意义（P＜0.05）;研究组治疗后的HA、Ⅳ-C、TBiL、ALT均低于对照组,ALB高于对照组,差异有统计学意义（P＜0.05）.研究组的1、2年HBV-DNA转阴率均高于对照组,差异有统计学意义（P＜0.05）.两组均无明显并发症.结论 拉米夫定联合阿德福韦酯治疗活动性乙型肝炎肝硬化效果明显,能显著改善患者肝功能,无严重并发症,值得临床推广应用.     

Current management strategies for hepatitis B in the elderly.

Despite the availability of an efficient vaccine, chronic hepatitis B virus (HBV) infection remains a major public health problem worldwide. The World Health Organization estimates that there are still 350 million chronic carriers of the virus who are at risk of developing chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Antiviral therapy consists of the administration of either interferon-alpha (IFN alpha) or lamivudine. In the elderly, specific issues should be addressed. Because of the long duration of viral infection, screening for HCC is warranted in these patients, as new therapeutic options are being developed. Antiviral treatment for chronic hepatitis B is indicated in patients with elevated transaminases, the presence of HBV replication, and inflammatory activity on liver histology analysis, providing the patient has no other serious health problem impacting on life expectancy. Since IFN alpha therapy may cause many general adverse effects, lamivudine may be the best current treatment option in this patient population. The pharmacokinetics of lamivudine in the elderly are slightly different from those in younger adults but this does not require dose adjustment, except in the presence of renal function impairment. However, the beneficial effects of lamivudine therapy must be weighed against the selection of drug-resistant mutants. New therapeutic strategies are now under evaluation and may be available in the future for the elderly population. Besides mass HBV vaccination programmes, people sharing a house with patients infected with HBV should be vaccinated to prevent viral transmission.