核苷类似物治疗拉米夫定耐药失代偿期肝硬化疗效观察

Nucleotide analogues in treatment of lamivudine-resistant patients with decompensated liver cirrhosis

目的核苷类似物用治疗发生拉米夫定耐药的肝硬化失代偿期患者,观察其疗效及安全性。方法选择拉米夫定治疗后产生耐药的HBsAg、HBeAb和HBcAb阳性、HBVDNA>105copies/L的肝硬化失代偿期患者51例,应用不同核苷类似物抗病毒治疗,于治疗24周,48周后观察疗效及不良反应。结果治疗后24周,48周后血清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治疗前(P<0.05);血清生化指标好转,与治疗前相比较有显著性差异(P<0.01);肝功能Child-Pugh计分好转,与治疗前相比较有显著性差异(P<0.01);两组比较,差异无统计学意义。结论阿德福韦联合拉米夫定、恩替卡韦(ETV)治疗拉米夫定耐药的肝硬化失代偿期患者均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,安全性好。

Objective To observe the efficacy and safety of nucleotide analogues in the treatment of lamivudine-resistant patients with decompensated liver cirrhosis. Methods Fifty-one decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus （HBV） mutants, positive HBsAg, HBeAb, and HBcAb, and HBV DNA level 〉 105copies/ml were treated with nucleotide analog. The clinical efficacy after 24 week and 48week and the adverse reaction during treatment were observed . Results After Two groups treatment for 24 and 48 weeks, decompensated cirrhosis patients were significantly improved in hver functions, with decreased Child-pugh score and HBV DNA level （ P 〈 0. 05 ）. There were no significant statistical of those levels and Child-Pagh scores between the two groups （P 〉 0. 05）. Conclusions Adefovir in combination with lamivudine and ETV have satisfied efficacy and safety in the treatment of lamivudine-resistant patients with decompensated liver cirrhosis.