恩替卡韦治疗YMDD变异的失代偿期乙型肝炎肝硬化临床观察

Entecavir in treatment of decompensated liver cirrhosis patients with YMDD mutation

目的:观察恩替卡韦治疗拉米夫定治疗过程中出现YMDD变异的失代偿期乙型肝炎肝硬化的疗效和安全性。方法:将28例在拉米夫定治疗过程中出现YMDD变异的失代偿期乙型肝炎肝硬化患者随机分为治疗组15例和对照组13例,两组均予保肝、利胆等常规内科综合治疗,在此基础上,对照组继续予拉米夫定100mg/d口服治疗、治疗组予恩替卡韦1mg/d口服治疗,疗程1年。结果:对照组有1例因出现肝细胞癌死亡、2例因并发上消化道大出血死亡,病死率为23.08(3/13);治疗组有2例在服用恩替卡韦6个月后,因无法承担费用而自动放弃治疗,余13例肝功能恢复情况及HBVDNA阴转率均优于对照组(P<0.01),病死率为0。结论:恩替卡韦治疗YMDD变异的失代偿期乙型肝炎肝硬化患者具有良好的疗效和安全性,能提高患者的生存质量,改善预后。

Objective.. To evaluate the clinical benefits and safety of Entecavir therapy in patients with decompensatedliver cirrhosis resulting from hepatitis B YMDD mutants during the course of treatment of lamivudine. Methods： 28 patients with decompensated liver cirrhosis with YMDD mutation were randomly divided into two groups： 15 patients in the treatment group and 13 in the control. The patients in control groups received routine therapy and continued to receive lamivudineat a dose of 100mg daily, however the patients in treatment group received routine therapy and Entecavir at a dose of lmg daily,and the course of treatment was 1 year. Results： In the control group, l case died of hepatoma and liver function failure,2 died of upper gastrointestinal bleeding;and in the treatment group,2 case was out off the regimen because of Economic reason after A half year of treatment. After 1 year of treatment,the rate of the liver function recovery and the rate of HBV DNA negativity in the treatment group were higher than that in the control group （P 〈 0. 01 ）. And the case fatality was 0 in treatment group, while 23.08% in the control group. Conclusions：Entecavir is effective and safefor patients with decompensated liver cirrhosis with YMDD mutation, and Entecavir can improve the prognosis of the patients.