肝炎肝硬化失代偿抗病毒治疗临床病理分析

The clinicophatholgic report of antivirus therapy in patients with fiver cirrhosis resulting from Hepatitis B.

目的比较肝炎肝硬化失代偿患者应用核苷类似物抗病毒治疗前后临床和病理方面的变化，探讨其抗病毒治疗的必要性、疗效和安全性。方法选择肝炎肝硬化失代偿患者80例，根据肝穿病理结果将其分为3组：拉米夫定组、阿德福韦酯组和对照组，常规保肝治疗相同，拉米夫定组加用拉米夫定片0．1g／d；阿德福韦酯组加用阿德福韦酯酯胶囊10mg／d，对照组不用任何抗病毒及调节免疫的药物，疗程36周，定期监测肝肾功能、凝血酶原时间（PTA）、HBVDNA定量指标，计算Child-Pugh分值，对部分肝穿组织病理变化进行比较。结果拉米夫定组及阿德福韦酯组Child—Pugh评分分别降低为3．9分和2．1分；HBV DNA定量分别降低为（4．1±0．9）copies／ml和（2．8±1．0）copies／ml；肝脏炎症积分均减少2以上；肝纤维化积分减少1以上，与对照组比较差异均有统计学意义（P均〈0．05）。结论肝炎肝硬化失代偿患者应用核苷类药物抗病毒治疗后临床与病理方面均有明显改善，抗病毒治疗对于肝炎肝硬化失代偿期非常必要且安全。

Objective To evaluate the clinicophatholgic benefits and safty of antivirus therapy in patients with liver cirrhosis resulting from hepatitis B. Methods 80 patients with HBV-ralated liver cirrhosis were divided into three groups by the histopathology of liver：group of lamivudine treated with lamivudine 100 mg once daily ;Adefovir group treated with Adefovir 10 mg once daily ;control group treated with liver protective treatment only. Liver and renal function, PTA and HBV DNA were regularly measured. The Child pugh-Turotte sore and histopathology was compared before and after treatment. All courses of treatment were 36 weeks. Results The scores of Child Pugh-Turotte sore in groups of lamivudine and Adefovir were lowered sinificantly （ 3.9 and 2.1 respectively）, the load of HBV-DNA was decreased also [ （4.1 ±0.9 ） copies/ml and （ 2.8 ±1.0） copies/ml ], liver inflammmation decreased by more than 2 scores and liver fiber was improved by more than one score, with obviously significant difference （P 〈 0.05） as compared with control group. Conclusion Patients with HBV-related cirrhosis treated with lamivudine and adefovir for antivirus are improved and antivirus is important and safe to those during cirrhosis decompensation.