拉米夫定治疗乙肝失代偿肝硬化的临床观察

目的：评价拉米夫定治疗HBV-DNA阳性的失代偿期肝硬化患者的疗效。方法：选择HBV-DNA≥104拷贝/m l的失代偿肝硬化患者60例,其中给予一般保肝、利尿等基础治疗者为对照组,在此基础上加用拉米夫定（每日100m g）者为治疗组,两组各为30例。观察患者治疗中丙氨酸转氨酶（ALT）、血清总胆红素（TB）、血清白蛋白（ALB）、凝血酶原活动度（PTA）、HBV-DNA定量等的变化,记录并发症发生情况,如死亡追溯死因。统计分析两组治疗过程中上述指标、Ch ild-Pugh评分及其转归和预后的差异。结果：（1）治疗组ALT、TB、ALB水平12周后均明显好于对照组,差异有显著性。（2）观察结束时治疗组23例（76.6%）患者有病毒应答,而对照组为4例（13.3%）。（3）观察结束时治疗组中A级8例、B级21例、C级1例,Ch ild-Pugh评分下降≥2分者22例（73%）;对照组A级1例、B级10例、C级11例,Child-Pugh评分下降≥2分者3例（10%）。（4）观察期内治疗组并发肝昏迷4例,肝肾综合征3例,肝癌1例;对照组则分别14例、10例、5例。治疗组死亡3例,对照组死亡8例。（5）治疗组共6例出现YMDD变异,5例出现病毒变异后加用阿德福韦酯10 mg/d继续治疗。结论：HBV-DNA阳性的失代偿期肝硬化患者服用拉米夫定治疗能快速抑制病毒复制,有效改善肝功能,减少并发症的发生,减少住院次数,阻止或延缓病情进展,预防肝癌发生。

Clinical Observation of Lamivudine in Treatment of 60 Cases of Hepatitis B with Positive Decompensate Cirrhosis

Objective：To assess the efficacy and safety of Lamivudine in therapy of hepatitis B DNA positive decompensate cirrhosis of liver. Methods ： 60 cases were retrospected. 30 patients in the treatment group were treated with routine treatment adding Lamivudine, whereas others in the countrol group were treated on routine. All the patients were following up for more than two years, and Child-pugh score, alanine aminotransferase, bilirubin,albumin,HBV- DNA,upper gastrointestinal hemorrhage, hepatic encephalopathy, and mortality were analysed to evaluate the effect of Lamivudine. Results：The condition of most of patients treated with Lmivudine （26/30） keep stability： the decrease in grade of Child-pugh and the indicators of liver function come back to normal level, except 3 in 30 patients died. There were more cases whose serum HBV-DNA below 103copies/ml in the treatment group than that in the control group （76.6% vs 13.3%）, There were more patients whose Child Pugh score decreased by more than 2 in the treatment group （73 % vs 10% ）. The rate of developing hepatic encephalopathy, hepatorenal syndrome and hepatocellular carcinoma in treatment group were 13. 3%,10%,3.33% respectively, lower than that in the control group （P〈0.05）. Less cases died in the treatment group （10%vs 26. 67% ,P〈0.05） YMDD mutation have been happened in 6 patients,and 5 patients add on adefovir to continue treating. Conclusion：Lamivudine treatment is beneficial in patients with hepatitis B DNA positive decompensate cirrhosis, It can inhibit HBV replication rapidly, prevent exacerbation, and improve living quality.