拉米夫定治疗失代偿期乙型肝炎肝硬化的临床观察

Efficacy and Safety of long-term lamivudine therapy in patients with decompensated liver cirrhosis secondary to hepatitis B

目的 研究拉米夫定对失代偿期乙型肝炎肝硬化的临床疗效和安全性。方法 2 8例乙型肝炎肝硬化患者给予拉米夫定 10 0mg/d口服 ,连用 2 4个月 ,设立对照组。在治疗开始前、治疗开始后 6个月、12个月和 2 4个月分别记录Child Pugh得分 ,并进行肝功能、肝纤维化标志物、HBV血清标志物以及血清HBVDNA定量检测。结果 2 8例肝硬化患者拉米夫定治疗后 ,血浆白蛋白显著升高 ,血清丙氨酸转氨酶和胆红素明显降低 ,血清Ⅲ型前胶原、Ⅳ型胶厚、层粘连蛋白和透明质酸水平较治疗前显著降低 ,血清HBVDNA阴转率明显高于对照组 (P <0 .0 0 5 ) ,HBVDNA水平较治疗前显著降低。治疗组Child Pugh计分平均降低 2 .5 ,5 4.2 %患者提高了分级 (12例从B到A ,1例从C到B) ,而对照组仅有10 .5 %的患者Child Pugh分级得到了改善 ,治疗组显著高于对照组 (P <0 .0 1)。不良反应的发生率为 3 2 .1% (9/2 8)。结论 拉米夫定能使HBV复制指标阳性的活动性肝硬化患者的病毒复制受到抑制 ,肝功能改善 ,肝纤维化程度降低 ,病情缓解。应用拉米夫定治疗肝硬化患者安全可靠。

Objective To evaluate the clinical benefits and safety of long-term lamivudine therapy in the patients with decompensated liver cirrhosis resulting from hepatitis B.Methods Thenty-eight patients with HBV-related decompensated liver cirrhosis were treated with lamivudine 100 mg once daily for more than 24 months.Before the treatment and at the sixth month,twelfth month and the twenty-fourth month after the treatment,Child-Pugh-Turcotte score was recorded and vein blood was drawn in order to test liver function,hepatic fibrosis markers,HBV markers and HBV DNA.Another 28 patients with HBV-related decompensated cirrhosis were enrolled for comparison.Results In the 28 HBV-related decompensated cirrhosis patients treated with lamivudine,the level of plasma albumin significantly increased,the levels of serum alanine aminotranferase and bilirubin significantly decreased,and the levels of serum propeptide Ⅲ procollagen,type Ⅳ collagen,laminin and hyaluyonite significantly decreased.After the treatment of lamivudine,the level of HBV DNA significantly decreased.The negative rate of HBV DNA in treatment group was significntly higher than that of control group (P<a0.005 ).Decrease in Child-Pugh-Turcotte score by 2.5 was seen in patients with lamivudine therapy,but 0.5 in control group.The Child-Pugh-Turcotte grade improved in 54.2% patients with lamivudine therapy (from B to A in 12 patients and from C to B in 1 patients),but 10.5% in control group(P<a0.01a).The rate of side-effects was 32.1%(9/28).Conclusion In HBV-related decompensated cirrhosis,lamivudine can achieve significant improvement in clinical status and liver function,decrease hepatic fibrosis and is effective in suppressing HBV replication.Lamivudine is safe in treating patients with HBV-related decompensated cirrhosis.