拉米夫定联合抗乙肝胎盘转移因子治疗活动性肝硬化临床观察

目的比较拉米夫定联合抗乙肝胎盘转移因子和单用抗米拉定治疗乙肝病毒复制活跃的活动性肝硬化长期临床疗效。方法 62例HBeAg和HBV-DNA阳性活动性肝硬化患者分为拉米夫定联合抗乙肝胎盘转移因子联合治疗组(30例)和单用拉米夫定对照组(32例),治疗24个月后随访6个月。结果治疗24个月后,联合治疗组46.4％病人获得HBeAg血清转换,对照组21.4％发生HBeAg血清转换(P<0.05)。同时联合组14.3％发生YMDD变异,而对照组46.4％发生变异(P<0.01)。两组病人HBV-DNA载量都明显下降,肝组织学获得进步。随访6个月,联合治疗组HBeAg血清转换率(64.3％)仍显著高于对照组(28.6％)。结论拉米夫定联合抗乙肝胎盘转移因子治疗病毒复制活跃的活动性肝硬化在HBeAg血清转换和YMDD变异上比单用拉米夫定有更好的临床作用。

A Long - Term Observation and Follow- up for Patients with Active Liver Cirrhosis ( Child B) After Treatment of Lamivudine Plus Anti - HBV Placenta Transfer Factor

Objective To compared the long-term efficacy of Lamivudine plus anti-HBV placenta transfer factor with lamivudine alone for the patients with HBV related liver cirrhosis(Child-Plugh-B).Methods A total of 62 patients with HBeAg/HBV-DNA positive cirrhosis was divided into two groups,one group received either Lamivudine plus anti-HBV placenta transfer factor(30cases)and the other received Lamivudine(32 cases)alone.Patients were treated for 24 months and followed for 6 months.Results At 24 month,46.4 percent of the pa- tients was achieved HBeAg seroeonversion in combination group while 21.4 percent of the patients in Lamivudine group achieved HBeAg serocon- version(P<0.05).In the meantime,14.3 percent of patients receiving Lamivudine plus anti-HBV placenta transfer factor had YMDD mu- tant,as compared with 46.4 percent in the group receiving lamivudine alone(P<0.01).However,HBV DNA load decreased rapidly in two groups(89.3 percent vs.85.7 percent,P>0.05).Liver biopsy showed improvement of necro-inflammation and fibrosis in two groups.After 6 months of follow-up,HBeAg seroconversion in patients who received Lamivudine plus anti-HBV placenta transfer factor are more than those who received lamivudine alone significantly(64.3 percent vs.28.6 percentP<0.05]).Conclusions In patients with HBeAg/HBV-DNA positive cirrhosis,Lamivudine plus anti-HBV placenta transfer factor offers superior efficacy over lamivudine alone,on the basis of HBeAg sero- conversion and YMDD mutant.