恩替卡韦联合阿德福韦酯对拉米夫定耐药乙肝肝硬化的疗效

目的 研究恩替卡韦（ENT）联合阿德福韦酯（ADV）治疗对拉米夫定耐药乙型肝炎肝硬化的临床疗效.方法 选取98例对拉米夫定耐药乙型肝炎肝硬化患者分为代偿期和失代偿期,两组患者均给予恩替卡韦（0.5 mg/d,qd）和阿德福韦酯（10 mg,qd）治疗.两组患者分别在治疗前、治疗24周和48周收集患者的血清样本检测HBV DNA阴转率、ALT复常率、评估Child-Pugh评分和与药物相关的不良反应.结果 治疗24周、48周时两组患者的HBV DNA阴转率、HBeAg阴转率、ALT复常率与治疗前相比均得到显著改善,治疗24周和48周时,两组HBeAg阴转率、HBV DNA阴转率、ALT复常率比较,差异有统计学意义（P＜0.05）.Child-Pugh评分与治疗前相比得到改善,但差异无统计学意义（P＞0.05）,治疗24周和48周时,两组Child-Pugh评分比较差异有统计学意义（P＜0.05）.未见不良反应和病毒学突破.结论 恩替卡韦联合阿德福韦酯治疗乙型肝炎肝硬化可以有效抑制乙肝病毒复制,延缓疾病进展,安全性良好.

Effect of entecavir combined with adefovir dipivoxil in treatment of lamivudine-resistant hepatitis B cirrhosis patients

Objective To explore the clinical effect of entecavir （ENT） combined with adefovir dipivoxil （ADV） in treatment of hepatitis B cirrhosis.Methods Ninety-eight lamivudine-resistant hepatitis B cirrhosis patients were treated with daily dose of ENT 0.5 mg and ADV 10 mg for 48 weeks at least.The rates of HBeAg loss,HBV DNA clearance,ALT normalization and Child-Pugh score at the 24th week,48th week observation points and the antiviral drugs associated adverse reaction were analyzed.Results At the 24th and 48th weeks,the rates of HBeAg loss,HBV DNA clearance,ALT normalization of the patients were significantly improved compared with those before treatment （P ＜0.01）,there were significant differences in the rates of HBeAg loss,HBV DNA clearance,ALT normalization between two groups after 24 weeks and 48 weeks treatment ; the Child-Pugh scores of the hepatitis B cirrhosis patients were not significantly improved compared with those before treatment （P ＞ 0.05）,there was significant difference in Child-Pugh seore between two groups after 24 weeks and 48 weeks treatment,adverse drug reaction and virological breakthrough were no found.Conclusion ENT combined with ADV in treatment of hepatitis B cirrhosis patients could inhibite the virus replication and delay disease progression.