拉米夫定对乙型肝炎失代偿期肝硬化门静脉血流动力学及预后的影响

The impact about lamivudine on portal hemodynamics and prognosis of hepatitis B decompensated cirrhosis

目的评价拉米夫定对失代偿期乙肝肝硬化患者门静脉血流动力学及预后的影响。方法选择HBVDNA≥10^4拷贝／ml的失代偿期肝硬化患者77例，对照组38例给予一般保肝、利尿、白蛋白等基础治疗，治疗组39例在此基础上加用拉米夫定100mg／d。观察两组患者ALT、TBIL、ALB、PTA、HBVDNA定量、门静脉血流动力学、Child—Pugh评分的变化及并发症和存活率，进行统计学分析。结果治疗组ALT、TBIL、ALB及HBVDNA水平12周后复常率均明显高于对照组（P〈0．05）；治疗组中Child～Pugh评分下降≥2分者22例（73％），对照组Child—Pugh评分下降92分者12例（10％），治疗3年后两组Child—Pugh评分均值比较有显著性差异（P〈0．05）；治疗3年后肝门静脉直径、血流速度、血流量，治疗组明显优于对照组（P〈0．05）；治疗组中肝肾综合征、肝性脑病、原发性肝癌的累计发生率明显低于对照组（P〈0，05）；治疗组存活率87．1％（34／39），明显高于对照组60．5％（23／38）（P〈0．05）。结论HBVDNA阳性的失代偿期肝硬化患者服用拉米夫定治疗能快速抑制病毒复制，有效改善肝功能，降低门静脉直径，改善门静脉血流，减少并发症的发生，阻止或延缓病情进展，提高存活率和生活质量。

Objective To evaluate the impact abuot lamivudine on portal vein hemodynamics and prognosis of decompensated hepatitis B in patients with liver cirrhosis. Methods To choose 77 patients with decompensated cirrhosis with HBV -DNA 〉t 104/ml,38 cases of control group, given the general treatment about protecting liver, diuretic, albumin, such as basic treatment,39 cases of treatment group on the basis of those added lamivudine scheduled to 100 mg/d. ALT, TBIL, ALB, PTA, HBV - DNA quantity, portal vein hemodynamics, Child - Pugh score changes and complications and survival were analyzed statistically. Results After 12 weeks, ALT, TBIL, ALB and HBV - DNA levels, the resumption of regular rates in the treatment group were obviously higher than in the control group （ P 〈 0. 05 ）. after the treatment 3 years two groups of Child - Pugh score means more obvious difference （ P 〈 0. 05 ） ; After the treatment of 3 years, for the hepatic portal vein diameter, blood flow rate, blood flow, the treatment group was obviously better than the control group （P 〈 0. 05 ） ; In the treatment group the cumulative incidence about hepatorenal syndrome, hepatic encephalopathy, primary liver cancer was obviously lower than the control group （ P 〈 0. 05 ） ; the survival rate of treatment group was 87.1% （34/39）, obviously higher than the control group 60.5 % （23/38） （ P 〈 0.05 ）. Conclusion HBV - DNA positive patients with decompensated cirrhosis lamivudine therapy can quikly suppress viral replication, effectively improve the liver function, reduced portal vein diameter, to improve the portal vein blood flow, reduce complications and prevent or delay the emergence of the disease progress, improve teat of survival and quality of life.