水飞蓟宾联合拉米夫定治疗慢性乙型肝炎活动性肝硬化疗效分析

Effects of Silibinin Combined with Lamivudine Treating the Liver Cirrhosis with Active Hepatitis B

目的 观察水飞蓟宾（商品名水林佳）联合拉米夫定治疗慢性乙型肝炎活动性肝硬化的长期疗效。方法 选择活动性肝炎肝硬化患者90例，采用分层随机抽样法分为治疗组和对照组。治疗组采用水林佳联合拉米夫定治疗；对照组采用退黄、降酶、抗纤维化、支持及对症处理。疗程6～67个月。观察两组患者血清病毒水平、肝功能、并发症的发生率及病死率。结果 两组患者HBVDNA阴转、HBeAg转换率间差异均有显著性意义（P〈0．05）；治疗组患者6～12个月、13～24个月、25～36个月、37～67个月酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸（YMDD）变异率分别为11．4％、22．7％、34．1％、38．6％。治疗后治疗组未发生YMDD变异患者的总胆红素（TBiL）、白蛋白（A）水平及Child—Pugh积分与对照组比较差异均有显著性意义（P〈0．05）；两组患者并发症的发生率、死亡率间差异亦均有显著性意义（P〈0．05）。结论 水林佳联合拉米夫定治疗活动性肝炎肝硬化，可抑制病毒复制，降低YMDD位点累计变异率，改善肝功能，降低并发症的发生率及病死率。

Objective To observe the long effects of traditional Chinese medicine silibinin combined with lamivudine treating the liver cirrhosis with active hepatitis B. Methods 90 cases of liver cirrhosis with active hepatitis B were randomized into study group （n =44, treated with silibinin and lamivudine） and control group （n =46, symptom controlling）. The treatment lasted for 6 - 67 months. The serum virus level, liver function, complications, the morbidity of bepatocellular carcinoma, and the mortality were analyzed. Results The negative conversion rate of HBV - DNA and HBeAg were significantly higher in study group than those in control group （ P 〈 0. 05 ）. The variation rates of YMDD in study group were 11.4%, 22.7%, 34. 1% and 38.6% respectively at the 6 - 12, 13 -24, 25 - 36, 37 - 67 month after the beginning of the medication. The level of total bilirubin （TBiL）, albumin （A） and the Child -Pugh score in study group patients without YMDD variation were significantly different from control group （ P 〈 0. 05 ）. The morbidity and mortality of complications were significantly lower in study group than those in control group （ P 〈 0. 05 ）. Conclusion The traditional Chinese medicine silibinin combined with lamivudine could inhibit the proliferation of HBV, decrease the variation rates of YMDD, improve the hepatic function, decrease the morbidity and mortality of complications.