恩替卡韦治疗失代偿期乙肝肝硬化病人的长期疗效观察

目的：观察恩替卡韦在失代偿期乙肝肝硬化病人长期治疗中的安全性和有效性。方法：回顾性分析2005年1月—2011年2月于解放军第三零二医院住院诊治的,具有完整3年随访资料的失代偿期乙肝肝硬化病人,给予恩替卡韦抗病毒治疗后1年、2年、3年血清病毒学指标的变化,肝功能指标,包括白蛋白（ALB）、总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、胆碱酯酶（CHE）,以及凝血酶原时间（PT）的变化;Child-Pugh评分及终末期肝病模型（model for end-stage liver disease,MELD）评分的变化,合并症的改善,肝癌的发生,以及药物不良反应的发生情况。结果：在全部112例病人中,恩替卡韦抗病毒治疗后1年、2年、3年时乙肝病毒脱氧核糖核酸（HBV DNA）的转阴率分别为92.9%、93.8%和95.5%,乙肝病毒e抗原（HBeAg）转阴率分别为26.2%、27.9%和47.5%,乙肝病毒e抗原/乙肝病毒e抗体（HBeAg/HBeAb）血清学转换率分别为4.5%、6.3%和9.8%。ALB、ALT、CHE、PT、Child-Pugh评分等各项指标较治疗前明显改善,差异有统计学意义（P〈0.05）;MELD评分较治疗前无明显变化,差异无统计学意义。与治疗前相比,恩替卡韦抗病毒治疗后2年、3年时TBIL显著降低（P〈0.05）。经恩替卡韦治疗后腹水及腹膜炎等并发症较治疗前明显改善,差异有统计学意义（P〈0.05）。抗病毒治疗过程中共有8人先后明确诊断为原发性肝癌,3年累积肝癌发生率为7.1%。结论：恩替卡韦治疗失代偿期乙肝肝硬化安全性良好,疗效确切,可以有效抑制乙肝病毒复制,改善肝功能及凝血功能,减少腹水及腹膜炎等并发症的发生,并有可能降低肝癌的发生率。

Long-term efficacy of entecavir therapy on hepatitis B patients with decompensated liver cirrhosis

Objective： To observe the efficacy and safety of entecavir in the prolonged treatment of hepatitis B patients （HBPs） with decompensated liver cirrhosis （DI.C）. Methods： HBPs with DLC who were admitted into No. 302 Hospital of PLA from January 2005 to February 2011 were retrospectively analyzed. The patients were given entecavir and had clinical follow-ups for more than 3 years. Laboratory detection was made in hepatitis B virus （HBV） and live function parameters, including albumin （ALB）, total bilirubin （TBIL）, alanine aminotransferase （ALT）, cholinesterase （CHE） and prothrombin time （PT）. Changes in Child Pugh scores and the model for end-stage liver disease （MELD） scores, the complication of DLC, the incidence of hepatocellular carcinoma （HCC） and adverse drug reactions （ADRs） were observed closely 1, 2 and 3 years after treatment with entecavir. Results： In all the 112 patients, the undeteetahle rates of serum HBV DNA were respectively 92.9%,93.8% and 95. 5%, 1, 2 and 3 years after treatment with entecavir. The clearance rates for hepatitis B e antigens （HBeAg） were 26. 2%, 27. 9% and 47. 5%, respectively. The seroconversion rates for HBeAg/hepatitis B e antibody （HBeAb） were 4.5%, 6.3% and 9.8% ,respectively. When compared with those before treatment, ALB, ALT, CHE, PT and Child-Pugh scores were all obviously improved, with statistical significance （P〈0.05）, while no significant differences could be noted in the scores of MELD, as compared with those before treatment. After 2 and 3 years of treatment with ente cavir, the levels of TBIL were decreased considerably （P〈0.05）. As compared with those before therapy, the incidence rates of aseites and primary peritonitis were decreased significantly （P〈0.05）. During entecavir treatment, 8 patients were diag nosed as primary HCC, with a total HCC incidence of 7.1%. Conclusion： Antiviral therapy with entecavir for HBPs with DLC is safe and effective, and research results indicate that it co