乙型肝炎肝硬化并脾亢脾部分栓塞术后阿德福韦酯疗效分析

目的观察乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术后阿德福韦酯疗效。方法41例乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术治疗后，21例口服阿德福韦酯10mg／d，疗程1年，对照组20例常规护肝、降酶等对症治疗。观察两组患者肝功能、血清肝纤维化指标、HBVDNA、HBeAg／抗．HBe血清学变化、Child-Pugh分级比较和不良反应。结果治疗组ALT、AST、TBil、ALB各项指标优于对照组，血清肝纤维化HA、PC-Ⅲ、Ⅳ—C各项优于对照组，治疗组HBVDNA转阴11例，对照组转阴1例，差异有统计学意义（Χ^2=8．5，P〈0．05）。治疗组发生HBeAg／抗．HBe血清转换者4例，对照组1例，差异有统计学意义（Χ^2=3．2，P〈0．05）。治疗组Child．Pugh分级为A级者9例，B级10例，C级2例；对照组A级6例，B级7例，C级7例，差异有统计学意义（Χ^2=5．9，P〈0．05）。阿德福韦酯治疗组未发现相关的肾功能损害和其他不良反应。结论乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术治疗，脾功能亢进可获得明显改善，但不能阻止乙型肝炎肝硬化病情进展，脾栓塞术后采用阿德福韦酯是较理想的长期抗病毒药物。

A clinical study on adefovir dipivoxil treatment for chronic hepatitis B patients with cirrhosis after partial splenic embolization

Objective To evaluate the efficacy of adefovir dipivoxil treatment for chronic hepatitis B patients with cirrhosis after partial splenic embolization. Methods Forty one chronic hepatitis B patients with cirrhosis after partial splenic embalization were randomly divided into two groups, the experimental group： twenty one patients treated with 10 mg of ADV per day; the control group： twenty patients treated with normal hepatoprotection. During the course of treatment, serum levels of ALT, AST, ALB, TBil, HBeAg, HBV DNA, PC-Ⅲ, Ⅳ-C, HA and Child-Pugh scores of the two groups were checked, compared and analyzed. Results Index including ALT, AST, ALB, TBil, PC-Ⅲ, Ⅳ-C and HA in the experimental group were superior to that in the control group. The difference of negtivity rate of HBV DNA （ 11 in the experimental group and only 1 in the control group） and seroconversion rate of HBeAg/HBeAb （4 in the experimental group and only 1 in the control group） were statistically significant （P 〈0.05 ）. According to their liver function, 9 patients of the experimental group belonged to Child-Pugh A, 10 belonged to Child-Pugh B, the other 2 belonged to Child-Pugh C. While 6 patients of the control group belonged to Child-Pugh A, 7 belonged to Child-Pugh B, the other 7 were Child-Pugh C, and the difference between the two groups was statistically significant. No drug related renal function impairment and other adverse reactions were found during the adefovir dipivoxil treatment. Conclusions Partial splenic embolization is a safe and effective therapy for hypersplenism in cirrhosis, but it can not prevent the aggravation of chronic hepatitis B patients with cirrhosis. Adefovir is a long-term efficient and safe drug for those patients.