替比夫定治疗失代偿期乙型肝炎肝硬化的临床观察

目的观察替比夫定治疗失代偿期乙型肝炎肝硬化患者48周疗效。方法 64例乙型肝炎肝硬化患者分成两组,34例给予替比夫定600mg/d治疗,30例给予拉米夫定100mg/d,持续治疗48周。观察治疗后病毒学、生化学、凝血酶原时间及Child-Pugh计分等变化情况。结果替比夫定组患者血清HBV DNA对数值在治疗前为（5.35±0.58）log10拷贝/ml,在治疗后12、24、36、48w时血清HBV DNA下降值依次为（1.88±0.84）log10拷贝/ml,（2.11±0.84）log10拷贝/ml,（2.17±0.74）log10拷贝/ml,（2.36±0.57）log10拷贝/ml,相比拉米夫定组下降值有明显的统计学差异（P〈0.05）。在治疗24周时ALT、AST明显下降,Alb、TBil、PT及Child-Pugh积分等指标均有所改善（P〈0.05）。结论替比夫定治疗于失代偿乙型肝炎肝硬化患者在48周内即能快速有效抑制病毒复制,使HBV DNA水平明显下降,同时可以改善肝功能及Child-Pugh积分等指标。

The effect of Telbivudine therapy in patients with decompensated cirrhosis caused by HBV

Objective To study the therapeutic efficacy of telbivudine in patients with decompensated cirrhosis resulting from chronic hepatitis B.Methods A total of 64 patients were divided into two groups,group one patients（n = 34） were received telbivudine 600mg and group two patients（n = 30） were treated with Lamivudine 100mg,orally per day for 48 weeks.The changes were observed at different times including virological and biochemical markers,PT and Child-Pugh score after antiviral therapy.Results In the telbivudine group,the mean serum HBV DNA level was（5.35 ± 0.58） log10 copies/ml,and the mean serum HBV DNA levels were（1.88 ± 0.84）,（2.11 ± 0.84）,（2.17 ± 0.74） and（2.36 ± 0.57） log10 copies/ml at 12,24,36 and 48 weeks,respectively.The mean reductions in serum HBV DNA levels were significantly greater in telbivudine group than lamivudine group（P 0.05）.After 24 weeks of therapy ALT,AST,albumin,total bilirubin and Child-Pugh scores were improved in the telbivdine group（P 0.05）.Conclusion Telbivudine rapidly and effectively inhibits the replication of HBV in cirrhosis resulting from chronic hepatitis B after 48-weeks of treatment and the reduction in the level of HBV DNA also improves the liver function,PT and Child-Pugh score.