拉米夫定治疗活动性肝炎肝硬化的疗效观察

目的 观察活动性肝炎肝硬化患者拉米夫定长程治疗的疗效及对停药后肝功能异常的对策探讨。 方法口服拉米夫定100 mg,每日一次,连服18个月治疗活动性肝炎肝硬化患者58例。观察治疗前后的临床症状体征、生化指标、病毒学改变情况、停药后情况及对策探讨。 结果 (1)35例(74.5％)患者治疗后病情缓解稳定,生活质量改善,child-pugh积分下降;肝功恢复正常或好转。(2)HBV DNA下降>10~3拷贝/ml;HBeAg阴转率达33.3％(13/39)。(3)10例停药后,在3-6个月随访期间肝炎复发再次住院。停药后肝功能异常的治疗:2例用干扰素治疗1个月后出现黄疸、肝损害加重,立即停药保肝处理后缓解;8例患者未加任何抗病毒药物,经加强保肝、调节免疫等治疗后,肝功能得到改善。 结论 乙型肝炎后肝硬化患者伴有活动性病毒复制及肝炎时,长程拉米夫定治疗可改善肝功能,阻止病情进展,提高生活质量;停拉米夫定后肝炎活动不宜应用干扰素治疗。

One year and half treatment with lamivudine in active cirrhosis resulting from chronic hepatitis B

Objective To study the therapy effect of long term lamivudine treatment on active cirrhosis following chronic hepatitis B, and explore the methods for abnormalities resulting from lamivudine withdrawing. Methods 58 patients received lamivudine 100 mg orally everyday for 18 months. The changes were observed and wrote down, including clinical symptoms and signs, aminotransferase, virology indexes, and the abnormalities after lamivudine withdrawing, then further to find out plans for the latter. Results (1) After lamivudine treatment, there were 35 patients whose situation stabilized, life quality improved, child-pugh score declined, and liver function turned better. (2) The level of HBV DNA decreased at least 10~3 copies/ml. HBeAg of 33.3% patients (13/39) became negative. (3)Among the 10 patients who stopped lamivudine of their own accord, and came again after 3-6 months because of hepatitis B recurring, two were treated with interferon for one month, then turning to liver-protecting methods for deteriorating, the other eight only received liver-protecting and immune-regulating treatment, whose liver function improved. Conclusions Long term treatment with lamivudine for active cirrhosis following chronic hepatitis B can improve liver function and life quality, prevent exacerbation. And it is not advisable to use interferon for hepatitis B relapsing after lamivudine withdrawing.