三种核苷类似物治疗肝硬化失代偿期患者的疗效比较

目的观察核苷类药物治疗乙型肝炎肝硬化失代偿期的疗效。方法将83例乙型肝炎肝硬化失代偿期患者随机分为四组。所有患者在保肝、对症治疗的基础上,分别给予拉米夫定(A组)100 mg/d、阿德福韦酯(B组)10 mg/d、恩替卡韦(C组)0.5 mg/d口服,对照组(D组)仅给予保肝、对症治疗。观察所有患者临床症状、体征、肝功能、凝血酶原时间活动度(PTA)、乙型肝炎病毒(HBV)DNA定量、乙型肝炎e抗原(HBeAg)转阴情况等。结果在抗病毒治疗过程中,A组患者死亡2例,另1例在治疗过程中出现YMDD酪氨酸(Y)、蛋氨酸(M)、2个天冬氨酸(D)]变异及时加用阿德福韦酯退出观察;B组患者死亡1例;C组患者无一例死亡;D组疗效最差,死亡4例。A、B、C组患者临床表现、肝功能及血清病毒学指标均较D组有明显改善,差异有统计学意义(P<0.01)。结论乙型肝炎肝硬化失代偿期患者应给予抗病毒治疗,可首选恩替卡韦,亦可选用阿德福韦酯或拉米夫定。

Effective comparison of three kinds of nucleoside analogues in treating liver decompensation of hepatitis B cirrhosis

Objective To observe the effect of nucleoside analogues in treating the decompensation stage of hepatitis B cirrhosis. Methods Eighty-three patients with the decompensation of hepatitis B cirrhosis were randomly divided into four groups. All were treated by the basic hepatoprotective and symptomatic treatment. The group A, B and C were separately given o- ral lamivudine （100 mg/d）,adefovir （10 mg/d） and enteeavir（0.5 mg/d）. The group D as control was given bepatoprotective and symptomatic treatment alone. The clinical symptoms, signs, change of liver function, PTA, quantitative HBV DNA, HBeAg nega- tive-conversion were observed among 4 groups. Results During antiviral treatment,2 cases in the group A died, 1 cases of the variation of tyrosine （Y）, methionine （M） and two aspartates （DD） occurred and exited from observation after adding adefovir. The group B had 2 cases of death and the group C had no death. The group D had 4 cases of death, showing worst effect.The clinical manifestations,liver function and serum virological indicators in the group A ,B and C were improved more obviously than the group D with statistical difference（P〈0.01 ）. Conclusion The patients with the decompensation stage of hepatitis B cirrhosis should accept the antiviral treatment. Entecavir can be used as first choice. Adefovir or lamivudine can be selected and used too.