拉米夫定联合阿德福韦酯治疗乙肝肝硬化失代偿期57例临床观察

目的观察拉米夫定联合阿德福韦酯治疗乙肝肝硬化失代偿期的疗效和安全性。方法57例乙肝肝硬化失代偿期患者均在保肝、对症、支持、防治并发症等综合治疗的基础上加用拉米夫定100mg／d和阿德福韦酯10mg／d口服，观察48周。比较患者在治疗前后的临床表现、生化学指标、病毒学改变、Child．Pugh分级情况。结果50例（87．7％）患者经治疗后病情缓解并稳定，肝功能明显好转或恢复正常，Child．Push积分下降，HBVDNA水平明显下降，部分出现HBeAg／抗HBe血清转换。死亡7例中HBeAg阴性6例，占HBeAg阴性患者的6／31（19．4％）。结论拉米夫定联合阿德福韦酯治疗乙肝肝硬化失代偿期可迅速显著地抑制HBVDNA的复制，促进肝功能的恢复，使Child．Pugh积分下降，缓解病情发展，并且药物安全性好。

Clinical observation of lamivudine combined with adefovir dipivoxil in treating 57 patients with decompensated liver cirrhosis caused by hepatitis B

Objective To observe the efficacy and safety of lamivudine combined with adefovir dipivoxil in treating 57 patients with decompensated liver cirrhosis caused by hepatitis B. Methods Fifty-seven cases of decompensate liver cirrhosis caused by hepatitis B were treated with lamivudine 100 mg/d and adefovir dipivoxil 10 mg/d on the basis of comprehensive treatments,such as liver function protecting,symptomatic and supportive treatments and complications preventing,the course was 48 weeks.The clinical symptoms,biochemical indicator,serum HBV DNA level,Child-Pugh degree scores before and after the therapy were compared. Results After the treatment,50(87.7%) patient’s clinical symptoms and liver function improved,Child-Pugh degree scores decreased,serum HBV DNA levels decreased,and the seroconversion of HBeAg to HBeAb occured in part of the 50 patients.Among the 31 HBeAg-negative patients,six patients(19.4%) died. Conclusion Lamivudine combined with adefovir dipivoxil in treating decompensated liver cirrhosis caused by hepatitis B can evidently and promptly inhibit the replication of HBV DNA,improve the liver function,and decrease the Child-Pugh degree scores.Both drugs are safe.