阿德福韦、拉米呋定联合治疗YMDD变异失代偿肝硬化临床观察

Adefovir dipivoxil and lamivudine in treatment of decompensated liver cirrhosis patients with YMDD mutation

目的:观察阿德福韦酯联合拉米呋定治疗YMDD变异的失代偿肝硬化的疗效和安全性。方法:采用随机分组的方法,将60例使用拉米呋定抗病毒治疗后出现YMDD变异的乙型肝炎肝硬化失代偿期患者作为研究对象,按1∶1的比例分为治疗组和对照组,治疗组予以护肝以及阿德福韦10mg/d联合拉米呋定100mg/d抗病毒治疗,对照组予以护肝,对症支持治疗。分别观察两组的血清生化学指标、HBV-DNA水平、肾功能以及不良事件发生率,并进行child-pugh评分。结果:治疗组血清HBV-DNA水平中位数下降幅度、病毒学应答率及生化学应答率均明显优于对照组(P<0.05);血清生化指标好转,与对照组相比较有显著性差异(P<0.01)。结论:乙肝肝硬化在拉米夫定治疗期间发生YMDD变异后改用阿德福韦酯联合拉米呋定治疗,可以较快出现血清病毒学应答,能改善肝功能,减缓病情发展,并且安全性好,值得推广应用。

Objective：To evaluate the efficacy and safety of adefovir dipivoxil and lamivudine in treatment of decompensated liver cirrhois patients with YMDD motifmntation during lamivudine therapy. Methods ：60 decompensated cirrhosis patients were divided into two groups-the control groups and the treated groups.The control groups were given conventional treatment while the treated groups were given lamivudine 100 mg/d and Adefovir dipivoxil 10 mg/d together with conventional treatment for 48 weeks. Results ：After lamivudine and Adefovir dipivoxil treatment for 48 weeks, decompensated cirrhosis patients were significantly improved in liver functions, with decreased Child-pugh score and HBV DNA level （P〈 0.05）. Conclusion：Adefovir dipivoxil and lamivudine has satisfied efficacy and safety in treatment of decompensated liver cirrhosis patients with YMDD motifmutation during lamivudine treatment.