拉米夫定治疗乙型肝炎肝硬化失代偿的2年随访观察

Follow up study of decompensated Hep B cirrhosis treated with Lamivudine for 2 years

目的观察拉米夫定治疗乙型肝炎肝硬化失代偿期病人的疗效。方法22例乙肝肝硬化失代偿患者均给予拉米夫定片100mg/d,口服治疗18月以上,最长约36月。最初2￣8周给予复方甘草酸单胺、白蛋白及利尿剂等对症治疗。不采用其他抗病毒、抗纤维化、降酶等药物治疗。3例发生YMDD变异患者给予阿德福韦或拉米夫定加保肝治疗。定期检测肝功能、HBV-DNA、免疫学标志、肝纤维化指标等。结果拉米夫定治疗6月时能有效抑制HBV-DNA,患者肝功能各项指标均有一定改善。治疗12和24个月除发生YMDD变异的患者外,患者肝纤维化指标明显下降,生物化学完全应答。结论拉米夫定能减轻肝硬化失代偿患者的肝病严重程度,提高病人的生活质量,延长患者生存时间,近期疗效满意。但长期应用拉米夫定有发生病毒变异、病情加重,甚至危及生命可能。发生病毒变异后应及时选用新的抗病毒药,并积极进行保肝治疗,以免出现危及生命的严重后果。拉米夫定的长期疗效仍有待于进一步观察。

[Objective] To evaluate the therapeutic effect in the treatment of Hep B decompensatory cirrhosis by Lamivudine. [Methods] 22 cases of Hep B cirrhosis were treated by Lamivudine （100 mg/d） for 18 to 36 months. In the first 2 to 8 weeks, only potenlin, albumin and diuretics but no antiviral or antifibrosis drugs were given. 3 cases of YMDD mutants received Adeforvir or Lamivudine plus hepatic protection therapy. All cases were checked regularly for liver function, HBV-DNA, cirrhosis indexes, etc. [Results] Imnivudine effectively inhibited HBV-DNA at the end of 6 months, and the liver functional indexes were improved. The cirrhosis indexes were decreased and biochem- ical fully reaction were achieved excepted those of YMDD mutant cases. [Conclusion] Lamividine could lighten the decompensated cirrhosis, improve and prolong the patient＇s life, it was effective for short-term therapy. But there was risk of mutation and getting worse （even to death） for taking long-term therapy. New antivrial drugs and hepatic protection therapy should be used in time when mutation oecured. More study are needed to determine the long-term effect of Lamivudine.