阿德福韦酯治疗YMDD变异的失代偿期乙型肝炎肝硬化临床观察

目的观察阿德福韦酯治疗拉米夫定治疗过程中出现YMDD变异的失代偿期乙型肝炎肝硬化的疗效和安全性。方法将28例在拉米夫定治疗过程中出现YMDD变异的失代偿期乙型肝炎肝硬化患者随机分为治疗组15例和对照组13例,两组均在保肝、利胆等常规内科综合治疗基础上继续接受拉米夫定100mg/d口服治疗,治疗组在上述基础上联合阿德福韦酯10mg/d口服,疗程1年。结果对照组1例因出现肝细胞癌死亡,2例因并发上消化道大出血死亡。治疗组1例在治疗一周时因出现血肌酐轻度升高退出。治疗1年时结果显示,治疗组肝功能恢复情况及HBVDNA阴转率均优于对照组(P<0.01),治疗组病死率为0%,对照组为23.08%。结论阿德福韦酯治疗YMDD变异的失代偿期乙型肝炎肝硬化患者有良好的疗效和安全性,能提高患者的生存质量,改善预后。

Adefovir dipivoxil in treatment of decompensated liver cirrhosis patients with YMDD mutation

Objective To evaluate the clinical benefits and safety of adefovir therapy in patients with decompensated liver cirrhosis resulting from hepatitis B YMDD mutants during the course of treatment of lamivudine.Methods 28 patients with decompensated liver cirrhosis with YMDD mutation were randomly divided into two groups:15 patients in the treatment group and 13 in the control.The patients in both groups received routine therapy and continued to receive lamivudine at a dose of 100mg daily,however the patients in treatment group received adefovir at a dose of 10mg daily,and the course of treatment was 1 year.Results In the control group,1 case died of hepatoma and liver function failure,2 died of upper gastrointestinal bleeding;and in the treatment group,1 case was out off the regimen because of the light increase of serum creatinine after 1 week of treatment.After 1 year of treatment,the rate of the liver function recovery and the rate of HBV DNA negativity in the treatment group were higher than that in the control group(P<0.01).And the case fatality was 0% in treatment group,while 23.08 % in the control group.Conclusions Adefovir is effective and safe for patients with decompensated liver cirrhosis with YMDD mutation,and adefovir can improve the prognosis of the patients.