拉米夫定联合地塞米松治疗慢性重型乙型肝炎早期的临床观察

目的：研究探讨拉米夫定联合小剂量地塞米松对慢性重型乙型肝炎（简称：CSHB）早期的疗效及安全性。方法：将35例CSHB早期患者随机分成两组，治疗组：在综合治疗基础上口服拉米夫定100mg／d，结合小剂量地塞米松5mg／次，间隔2-3d，好转后延长给药间隔时间至停用；对照组：仅予综合治疗。治疗12周后进行统计分析。结果：治疗组肝功能指标与对照组相比明显改善，TBiL：（35．80±14．50）μmol／LVS（128．50±65．80）μmol／L、ALT：（55．60±20．70）U／LVS（190，80±42．50）U／L）、PTA：（70．20±14．40）％VS（45130±8.80）％及ALB：（36.20±3．50）g／LVS（32．20±2．80）g/L）；住院天数明显缩短（67．50±0．50）dVS（107．40±24．50）d：P〈0．01或P〈0．05。治疗组的生存率为94．44％（17／18），对照组52．94％（9／17），P〈0．01；存活者中治疗组的HBV-DNA阴转率88．23％（15／17），对照组为22．22％（2／9），P〈0．01；且无明显不良反应。结论：在综合治疗基础上，拉米夫定联合小剂量地塞米松治疗可有效控制CSHB早期的病情，改善患者临床症状，促进肝功能指标恢复，缩短住院时间，提高存活率，改善生活质量。

Clinical Efficacy of Lamivudine Combined with Low Dosage Dexamethasone in the Treatment of Patients with Early Chronic Severe Hepatitis B

Objective:To investigate the effect and safety of lamivudine combined with low dosage dexametha- sone in the treatment of patients with early chronic severe hepatitis B.Methods:35 patients with early severe hepatitis B were randomly divided into two groups.18 cases in treatment group administrated lamivudine combined with low dosage dexamethasone 5 mg in an interval of 2～3 days,but 17 cases in control group only received ordinary compre- hensive treatment.Results:As to the improvement of liver functions,the therapy group was better than the control group (P<0.01).The survival rate of therapy group (94.44%,17/18) was higher than that of control group (52.94%,9/17), (P<0.01).The percentage of serum HBV-DNA negative conversion among the survivals was 88.23%(15/17) VS 22.22% (2/9),(P<0.01).Conclusion:The treatment of lamivudine combined with low dose dexametha-sone is superior to the ordinary comprehensive treatment for the patients with early chronic severe hepatitis B.