阿德福韦治疗活动性乙型肝炎肝硬化临床观察

Clinical analysis on adefovir dipivoxil for the treatment of symptomatic hepatitis B cirrhosis

目的观察阿德福韦治疗活动性乙型肝炎肝硬化的疗效和安全性。方法选择活动性乙型肝炎肝硬化78例,在综合治疗的基础上,加服阿德福韦10 mg,每日一次作为治疗组42例,仅采用护肝、支持等综合治疗者作为对照组36例。两组病例均治疗6个月后观察比较肝功能、HBV DNA、Ch ild-Pugh评分等,以评价疗效。结果治疗组治疗后平均值:TB IL为35.2±15.1,ALB为34.6±7.1,ALT为49.2±20.6,AST为56.2±23.6,PTA为46.2±9.8,Ch ile-Pugh评分为5.9±1.7;对照组治疗后平均值:TB IL为59.2±22.5,ALB为31.2±5.9,ALT为88.4±31.6,AST为84.7±27.9,PTA为38.1±8.1,Ch ild-Pugh评分为8.2±2.1,治疗组优于对照组(P<0.01);HBV DNA阴转率治疗组为52.38%(22/24),对照组为16.67%(6/26),2组之间差异有显著性(P<0.01);HBeAg阴转率治疗组为11.9%(5/42),对照组为8.33%(3/36),2组之间差异无显著性(P>0.05),考虑与观察时间过短有关。治疗组有1例发生HBeAg/HBeAb的血清学转换。而对照组患者无血清学转换。结论阿德福韦治疗活动性乙型肝炎肝硬化能有效控制病毒复制,改善肝功能,从而延缓病情进展。治疗中患者耐受性良好,未见相关不良反应。

Objective To evaluate the efficacy and safety of adefovir dipivoxil （ADV） in the treatment of symptomatic hepatitis B cirrhosis. Mechods Patients who met the criteria were randomized into adefovir dipivoxil group or control group. Both groups received ordinary liver protection drugs while patients in ADV group took additional 10 mg of ADV once a day during 6 monthes. Some laboratory examinations such as ALT, AST, HBV-DNA and Child -Pugh score were observed at the begining and the end of the test respectively. Results At the end of the test, the average levels for the ADV group were as the follows ：TBIL 35.2±15. 1, ALB 34. 6±7. 1, ALT 49. 2 ± 20. 6, AST56. 2 ± 23.6, PTA 46.2 ± 9. 8, Child-Pugh score 5.9 ± 1.7 ; the control group ： TBIL 59. 2 ± 22.5, ALB 31.2 ± 5.9, ALT 88.4 ± 31.6, AST 84.7±27. 9, PTA 38.1± 8. 1, Child-Pugh score 8.2±2. 1 ,The results between the control group and experiment group had significant differences （ P 〈0. 01 }. The clearance rates of HBV DNA in ADV group were 52. 38% （22/24） and in control group were 16. 67% （6/26） ,which had significant differences （ P 〈 0.01）. The clearance rates of HBeAg in ADV group were 11.9% （ 5/42） and in control group were 8. 33% （ 3/36） ,which had no significant differences （ P 〉 0. 05）. This might have something to do with the shorter test period. There was one case of the HBeAg to HBeAb seraconversion in the ADV group while none in the control group. Conclusion In the study ,treatment with 10 mg adefovir dipivoxil daily significantly reduced serum HBV DNA levels ,normalized alanine aminotransferase levels and delayed the course of disease. The patients tolerated well and no adverse effects were observed.