恩替卡韦治疗失代偿期乙型肝炎肝硬化的疗效观察

目的观察恩替卡韦治疗失代偿期乙型肝炎肝硬化患者48周时的疗效。方法肝硬化患者随机分为两组,分别给予口服恩替卡韦0.5mg/d和拉米夫定100mg/d。观察24、48周时肝功能、凝血酶原活动度（PTA）、血清学、病毒学、肝纤维化指标、Child-Pugh积分等变化情况。结果 24周时肝功能、PTA、肝纤维化指标和Child-Pugh积分等均有所改善,但两组间差异无统计学意义（P〉0.05）,随着疗程的延长无明显变化。恩替卡韦组在24、48周时分别有26.1%（6/23）及30.4%（7/23）的患者出现HBeAg血清学转换,但两组间差异无统计学意义（P〉0.05）。24、48周HBV DNA水平下降值、HBV DNA阴转率恩替卡韦组高于拉米夫定组（P〈0.05）。结论恩替卡韦能有效、快速抑制失代偿期乙型肝炎肝硬化患者的病毒复制,改善肝功能。

Clinical effect of entecavir in patients with decompensated hepatitis B cirrhosis

Objective To study the therapeutic efficacy of 48-week entecavir treatment in patients with decompensated hepatitis B cirrhosis.Methods Patients with decompensated hepatitis B cirrhosis were randomly divided into two groups as entecavir group（patients treated with entecavir 0.5 mg per day）,and lamivudine group（patients treated with lamivudine 100 mg per day）.Serum levels of ALT,AST,Alb,TBil,HBeAg,HBV DNA,PC,IVC,LN and HA,renal function tests and Child-Pugh scores of the two groups were observed and analyzed at 24th and 48th weeks.Results At week 24 ALT,AST,Alb,TBil,PTA,serum markers of hepatic fibrosis and Child-Pugh score were improved;however,there was no significant difference between the two groups（P 0.05）.The rates of HBeAg/anti-HBe seroconversion were 26.1%（6/23） and 30.4%（7/23） at week 24 and 48 in entecavir group,respectively.But there was no statistically significant difference between the two groups（P 0.05）.The mean reduction of serum HBV DNA and the proportion of patients with undetectable serum HBV DNA were greater in entecavir group than lamivudine group（P 0.05） at week 24 and 48.Conclusion Entecavir can rapidly and effectively inhibit the replication of HBV in patients with decompensated hepatitis B cirrhosis and improve the liver function.