摘要
目的 观察门脉高压围手术期乙肝病毒 (HBV)活动情况及拉米夫定对其防治效果。方法 对 4 4例乙型肝炎后肝硬化并门脉高压症患者随机分组 ,观察组 2 2例在围手术期每日 1次给予拉米夫定 10 0mg口服 ,进行HBVDNA定量及其他检查 ;对照组在围手术期不进行抗病毒治疗 ,其他检测同观察组。结果 对照组HBVDNA定量 ,在术后 1周内、2周内较术前增高值具有极显著性意义 (P <0 .0 1) ,观察组术后 1周、2周HBVDNA定量较术前降低值亦有极显著意义 (P <0 .0 1) ,皆低于安全治愈阈值 ;两组术前、术后Child分级、ALT比较差异无显著性意义 (P >0 .0 5 )。术后 2周内并发症发生率比较 ,差异有显著性意义 (P <0 .0 5 )。结论 外科干预可激活HBV的复制能力 ,须加强门脉高压围手术期对HBV的防范。拉米夫定有强大的抗HBV功能 ,可短期内迅速降低HBVDNA的量至安全范围。应用拉米夫定可以预防和抑制门脉高压围手术期HBV的活跃 ,减少术后并发症的发生 。
Objective\ To study the activity of hepatitis B virus and therapeutic and preventive efficacy of lamivudine in patients with active hepatitis B in portal hypertension perioperation.Methods\ 44 hepatitis B patients with portal hypertension treated from January 2001 to May 2003,once every day were divided into two groups randomly. 22 patients as treatment group were treated by lamivudine 100 mg once every day perioperatively. Other 22 patients were as control group, who wasn′t given anti-virus medicine. HBV DNA with assay of quantitative polymerase chain reaction(QPCR)and other examinations were detected preoperatively and postoperatively.Results\ The copies of serum HBV DNA in control group at 1 and 2 week postoperation were significantly higher than that preoperation(P<0.01);The copies of serum HBV DNA in treatment group at 1 and 2 weeks of postoperation were significantly lower than that of preoperation(P<0.01),all of them were in the safety threshold;Compared with control group, there was no significant difference in serum ALT and Child′s grade preoperatively and postoperatively. There was significant difference in the complications at two weeks postoperation(P<0.05). Conclusion\ Surgical procedure may result in HBV replication. Anti-virus treatment should be done perioperatively. Replication of HBV can be inhibited by lamivudine to the safety threshold within a short time,and the complications of operation can be reduced,though lamivudine doesn′t improve the liver function.
