阿德福韦酯治疗慢性乙型肝炎、肝硬化代偿期和失代偿期患者2年疗效比较

Two-year efficacy of adefovir dipivoxil for the treatment of chronic hepatitis B,compensated or decompensated cirrhosis

目的观察慢性乙型肝炎(乙肝)、乙肝肝硬化代偿期和失代偿期患者接受阿德福韦酯(ADV)抗病毒治疗2年的疗效。方法对初治的慢性乙肝32例(慢性乙肝组)、乙肝肝硬化代偿期10例(肝硬化代偿期组)和失代偿期14例(肝硬化失代偿期组)应用ADV治疗2年,治疗前和治疗后每3个月检测ALT等生化指标及HBVDNA等病毒学指标。结果 3组患者在治疗前各项指标基线水平无显著差异,具有可比性。ADV治疗1年和2年时,3组ALT的复常率和HBeAg血清学转换率之间差异无统计学意义(P>0.05)。治疗2年时慢性乙肝组HBVDNA水平下降的中位数为5.9log10U/ml,肝硬化代偿期组为6.2log10U/ml,肝硬化失代偿期组为2.9log10U/ml。肝硬化失代偿期组在治疗6个月后的病毒学应答比慢性乙肝组和肝硬化代偿期组差。结论接受ADV治疗2年的慢性乙肝、肝硬化代偿期和失代偿期患者中,肝硬化失代偿期患者病毒学应答差。

Objective To investigate 2-year antiviral efficacy of adefovir dipivoxil （ADV） on the patients with chronic hepatitis B, compensated or decompensated cirrhosis. Methods The treatment-naive patients with chronic hepatitis B （32 cases, CHB group）, compensated cirrhosis （10 cases, compensated cirrhosis group） and decompensated cirrhosis （14 cases, decompensated cirrhosis group） were treated with ADV for 2 years. Biochemical markers such as ALT and virological markers such as HBV DNA were detected at baseline and at every 3-month interval. Results The baseline characteristics of the 3 groups were comparable with no significant difference. ALT normalization rate and HBeAg seroconversion rate of the 3 groups were not significantly different after 1- year and 2-year ADV treatment （P〉O.05）. After 2-year ADV treatment, median reduction of HBV DNA levels was 5.9 log10 U/ml in CHB group, 6.2 log10 U/ml in compensated cirrhosis group, and 2.9 log10 U/ml in decompensated cirrhosis group. Virologic response in decompensated cirrhosis group was worse than that in CHB group or compensated cirrhosis group after 6-month ADV treatment. Conclusion After ：2 years of ADV treatment, virologic response in the patients with decompensated cirrhosis is worse than that in the patients with CHB or compensated cirrhosis.