肝复乐联合恩替卡韦治疗乙型肝炎肝硬化的疗效评价

目的评价恩替卡韦联合肝复乐片治疗乙型肝炎肝硬化的临床疗效。方法121例活动性乙型肝炎肝硬化患者完全随机分为观察组（58例）和对照组（63例）。对照组在护肝、对症等常规治疗基础上口服恩替卡韦0．5mg／d，观察组在对照组基础上口服肝复乐片3g/次、3次／d，疗程均为48周。均随访24周，随访期间均继续服用恩替卡韦。结果治疗24周后2组患者肝功能指标均有改善，观察组较对照组更明显[ALT：（50±31）U／L比（64±40）U／L，总胆红素：（33±19）μmol／L比（43±24）μmot／L，白蛋白：（34±8）g／L比（33±9）g／L，均P〈0．05]；同一时段HBVDNA转阴率观察组与对照组比较差异无统计学意义；2组患者的门静脉宽度及脾脏厚度自48周始均有不同程度缩小，至随访24周末，观察组的门静脉宽度及脾脏厚度缩小较对照组更明显[（1．29±0．29）cm比（1．33±0．29）cm，（4．1±0．7）cm比（4．2±0．9）cm，P〈0．05]；观察组与对照组患者Child—Pugh评分分别由治疗前（9．8±1．5）分和（9．54-1．1）分降至治疗后（7．2±1．4）分和（7．1±1．6）分，2组治疗后比较差异无统计学意义（P〉0．05）。结论恩替卡韦联合和肝复乐片治疗活动性乙型肝炎肝硬化能持续抑制病毒复制，促进肝功能恢复。

Effect of combination of ganfule and enticavir on liver cirrhosis with chronic hepatitis B

Objective To observe effect of combination of ganfule and enticavir on liver cirrhosis with chronic hepatitis B. Methods All 121 cases with liver cirrhosis with hepatitis B were randomly divided into two groups： control group （63 cases） and treatment group （58 cases）. Both groups were administered with routine therapy and enticavir （0.5 mg, qd） ; the treatment group had extra ganfule （6 tablets, tid, for 48 weeks）. Results After treatment, the liver function of patients in the two groups were both ameliorated obviously, and the liver function of patients in the treatment group was more remarkably ameliorated than control group （P 〈 0.05 ）. The level of HBV DNA was decreased in both groups. The diameter of portal vein and the thickness of spleen of patients were reduced significantly in both groups after 48 weeks. After 24 weeks the diameter of portal vein and the thickness of spleen in treatment group were reduced more significantly than those in control group. The Child-Pugh score of patients in observation group and control group decreased from （9.8 ± 1.5 ） scores and （9.5 ± 1.1 ） scores to （7.2 ± 1.4） scores and （7.1 ± 1.6） scores after treatment, respectively. Conclusions The combined therapy of ganfule and entieavir on liver cirrhosis with chronic hepatitis B can inhibit HBV replication, ameliorate liver function and decrease Child-Pugh score.