拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化的疗效观察

目的:观察拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化的疗效。方法:将68例失代偿期乙型肝炎肝硬化患者随机分为3组,在保肝治疗的基础上,A组给予拉米夫定(100 mg/d)、阿德福韦酯(10 mg/d),B组给予拉米夫定(100 mg/d),C组给予阿德福韦酯(10 mg/d),治疗为48周。观察所有患者丙氨酸氨基转移酶复常率,HBeAg/HBeAb血清转换率、HBVDNA阴转率以及Child-Pugh评分。结果:通过抗病毒治疗,3组无一例死亡。随治疗时间的延长,A组患者ALT复常率逐渐增高,且与B组和C组相比,治疗48周末ALT复常率明显增高(P0.05)。Child-Pugh评分有明显改善(P0.01)。A、B、C组HBeAg/HBeAb血清学转换率分别为20.8%、13.6%、9.1%,A组与B、C组比较差异无统计学意义(P0.05);A、B、C组HBeAg阴转率分别为62.5%、31.8%、27.3%,A组与B、C组比较差异有统计学意义(P0.05)。结论:失代偿期乙型肝炎肝硬化患者使用拉米夫定联合阿德福韦酯抗病毒治疗能快速抑制HBV DNA的复制,有效提高丙氨酸氨基转移酶的复常率,改善肝功能,延缓病情发展,实现肝硬化治疗的目标。

The curative effects of lamivudine and adefovir dipivoxil combined antiviral treatment on decompensated period hepatitis B liver cirrhosis

Objective:To observe the effects of nucleoside drugs combination therapy against decompensated period Hepatitis B liver cirrhosis. Methods:Sixty-eight cases with decompensated period Hepatitis B liver cirrhosis were divided into three groups randomly:based on the routine therapy,patients in A group were treated with lamivudine 100 mg/d and adefovir dipivoxil 10 mg/d;patients in B group were treated with lamivudine 100 mg/d,and with adefovir dipivoxil 10 mg/d in C group.After treatment for 48 weeks,the ALT recovery rate,HBeAg/anti-HBe sero-conversion rate,HBV DNA negative rate,and Child-pugh score were observed. Results:Through the antiviral treatment in these three groups,no death was happened.The ALT recovery rate in A group had a certain degree improvement with time,and in contrast to B and C group,the ALT recovery rate was increased significantly after 48 weeks treatment.The Child-pugh scores in all group had improved remarkably.HBeAg/anti-HBe sero-conversion rate in A,B,and C group was 20.83%,13.63% and 9.1%,respectively,there had no statistical differences among the three groups(P>0.05).HBeAg negative rate in A,B,and C group was 62.5%,27.3% and 22.7%,in contrast to A group,there had significant differences about HBeAg negative rate in B and C group(P<0.05). Conclusions:Lamivudine and adefovir dipivoxil combined antiviral treatment for decompensated period Hepatitis B liver cirrhosis can rapidly control the copy of HBV DNA,improve liver function effectively,delay the progress of disease,and finally achieve the treatment goal against liver cirrhosis.