阿德福韦酯治疗失代偿期乙型肝炎肝硬化疗效评价

目的观察阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者肝功能、凝血功能、HBV DNA、Child-Pugh评分、并发症发生率和病死率变化,评价其对患者的治疗效果.方法85例失代偿期乙型肝炎肝硬化患者被分为阿德福韦酯（ADV）组（53例）和对照组（32例）.两组均观察2年.结果在治疗48周时,ADV组AST、ALT（62.6±28.5U/L、56.8±21.2U/L）明显低于对照组（92.6±42.5U/L、87.8±34.2U/L,P〈0.01）,ALB、PTA（31.5±5.0g/L、47.4±8.5%）明显高于对照组（28.5±4.2g/L、37.5±6.5%,P〈0.01）;ADV组HBV DNA水平、Child-Pugh评分、腹水发生率分别为3.8±1.1lgcopies/ml、7.0±1.8和35.8%,明显低于对照组6.6±1.8lgcopies/ml、10.1±2.3和79.3%（P〈0.01）;在治疗96周时,ADV组AST、ALT、TBil、GLO明显低于对照组,ALB、PTA明显高于对照组（P〈0.01）;ADV组HBV DNA水平和Child-Pugh评分均低于对照组（P〈0.01）;并发症如消化道出血、腹水、慢性肝衰竭发生率分别为20.0%、12.0%和2.0%,明显低于对照组的75.0%、37.5%和29.2%（P〈0.05或P〈0.01）. ADV组病死率（5.7%）明显低于对照组（25.0%,P〈0.05）.结论阿德福韦酯明显抑制失代偿期乙型肝炎肝硬化患者HBV的复制,改善其肝功能和凝血功能,降低其并发症发生率和病死率.

Evalution of curative effect of adefovir in patients with hepatitis B virus-related decompensated cirrhosis

Objective To evaluate the effect of aefovir dipivoxil（ADV） on patients with hepatitis B virus （HBV）-related decompensated cirrhosis. Methods 85 patients with HBV-related dccompensated cirrhosis were divided into ADV group （n=53） and control group （n=32）. There were followed-up for 2 years. Results At 48 weeks,serum AST and ALT in ADV group were 62.6±28.5u/L and 56.8±21.2u/L,respectively,much lower than in control group （92.6±42.5u/L and 87.8±34.2u/L,P〈0.01）,ALB and PTA were 31.5±5.0g/L and 47.4±8.5%,much higher than in control group （28.5±4.2g/L and 37.5±6.5%,P〈0.01）;serum HBV DNA level,Child-Pugh score and ascites incidence in ADV group were 3.8±1.11gcopies/ml,7.0±1.8 and 35.8%,respectively,much lower than those in control group（6.6±1.81gcopies/ml,10.1±2.3 and 79.3%,P〈0.01）;At 96 weeks,the AST,ALT,TBil and GLO in ADV group were significantly lower than those in control group （P〈0.01）,ALB and PTA were significantly higher than those in control group （P〈0.01）. HBV DNA level and Child-Pugh score in ADV group were significantly lower than those in control group （P〈0.01）,the incidence of complications including gastrointestinal bleeding,aseites and chronic liver failure in ADV group were 20.0%,12.0% and 2.0%,respectively,much lower than those in control group（75.0%,37.5% and 29.2%,P〈0.05 or P〈O.01）,and the fatality rate in ADV group （5.7%） was significantly lower than that in control group （25.0%,P〈0.05）. Conclusion Adefovir dipivoxil can inhibit HBV replication,improve liver function and reduce the mortality of patients with HBV- related decompensated cirrhosis.