拉米夫定治疗失代偿性乙型肝炎肝硬化的临床观察

Treatment of Hepatitis B virus(HBV) Induced Decompensated Cirrhosis with Lamivudine

目的:探讨拉米夫定治疗失代偿性乙型肝炎肝硬化的临床疗效及安全性。方法:64例失代偿性乙型肝炎肝硬化患者采用拉米夫定治疗,必要时给予利尿、人血浆白蛋白等对症支持治疗,并观察64例患者治疗前及治疗3、6、12个月后临床症状及体征和生化指标、血液学指标、病毒学指标改变及耐药发生情况。结果:与治疗前比较,64例患者治疗后,临床症状及体征明显改善(P<0.01);血清ALT、AST及总胆红素水平均下降(P均<0.01),血清白蛋白含量增加(P<0.05,P<0.01),Child-pugh评分下降(P<0.05,P<0.01);外周血白细胞及血小板计数水平均有明显增高(P均<0.01);血清HBV DNA定量水平显著下降(P<0.01);病毒耐药者12例,耐药发生率18.75%。结论:失代偿性乙型肝炎肝硬化患者长程拉米夫定治疗可有效阻止病情进展,并可提高患者生活质量。

Objective：To evaluate the therapeutic effects and safety of long-term Lamivudine treatment on HBV-induced decompensated cirrhosis. Methods： Sixty-four patients with decompensated cirrhosis were given Lamivudine, when necessary, plus diuresis, human serum albumin（HAS） and other symptomatic therapy. The clinical symptoms,signs and changes of biochemical, hematological and virological index, and drug fast occurrence of the patients were observed before and after Lamivudine treatment for 3,6 and 12 months. Results： Clinical symptoms and signs of the 64 patients treated with Lamivudine turned better greatly（P〈0.01） ;serum ALT, AST and total bilirubin decreased（P〈0.01）, serum albumin levels increased（P〈0.05） （P〈0.01）,and Childpugh grades decreased（P〈0. 05） （P〈0.01）. Peripheral white blood cells（PWBC） and platelet counts were significantly higher levels （P〈0.01） ; Serum HBV DNA quantitive levels decreased significantly （P〈0.01） ; Twelve cases of virus resistance were observed to therapeutic reagents. The rate of drug fast was 18.75%. Conclusion： Long-term Lamivudine treatment for HBV-induced decompensated cirrhosis can effectively prevent the progress of the disease, and is beneficial for improving the patient＇s life quality.