核苷(酸)类似物治疗失代偿期乙肝肝硬化的随访研究

Follow up Study of HBV-induced Decompensated Cirrhosis Treated with Nucleot(s)ide Analogues

目的观察中国上市的4种核苷(酸)类似物拉米夫定(lamivudine,LAM)、阿德福韦酯(adefovir,ADV)、恩替卡韦(entecavir,ETV)和替比夫定(telbivudine,LDT)治疗失代偿期乙肝肝硬化对病毒复制、肝功能以及病程进展的影响。方法接受及未接受核苷(酸)类似物抗病毒治疗的失代偿期乙肝肝硬化患者52例,中位随访时间为11个月,在随访开始、第1年每3月1次、以后每6月1次,定期监测HBV DNA、肝功能、Child-Pugh评分、MELD评分等指标和安全性,对比用药前后各项指标变化。结果共111例符合入组条件的乙肝肝硬化失代偿期患者,因各种原因排除59例,最终52例入选,其中治疗组40例,对照组12例。对照组中HBV DNA、血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、门冬氨酸氨基转移酶(aspartateaminotransferase,AST)、白蛋白(albumin,ALB)、总胆红素(total bilinobin,TBIL)、胆碱酯酶(cholinesterase,CHE)、国际标准化比值(international normalized ratio,INR)、Child-Pugh评分、MELD评分在随访期间差异无统计学意义;在治疗组中,HBV DNA、ALT、ALB、CHE、INR、Child-Pugh评分在核苷(酸)类似物治疗前后有显著改善(P<0.05),而AST、TBIL、MELD评分在治疗前后无明显变化。结论失代偿期乙肝肝硬化患者应用核苷(酸)类似物治疗,可以抑制HBV DNA的复制,改善肝功能,稳定或逆转疾病进展,安全性较好。

Objective To observes the efficacy of the four nucleot（s）ide analogues including lamivudine,adefovir,entecavir and telbivudine in treatment of HBV-induced decompensated cirrhosis.Methods Patients with HBV-induced decompensated hepatitis B cirrhosis treated with and without nucleot（s）ide analogues（NAs） were followed up for a median of 11 months.HBV DNA,liver function,Child-Pugh-Turcotte scores,and MELD scores.Results A total of 52 patients were enrolled in this study after excluding 59 patients out of 111 patients with HBV-induced decompensated hepatitis B cirrhosis.Forty patients were assigned into the NAs group and 12 patients into the control group.In the control group,the HBV DNA,ALT,AST,ALB,TBIL,CHE,INR,Child-Pugh scores and MELD scores had no improvement between as compared with the baseline values and the end-of-follow up values.In the NAs group,the HBV DNA,ALT,ALB,CHE,INR,Child-Pugh scores had significant improvement（P0.05） and AST,TBIL,MELD scores had no improvement（P0.05）.Conclusion Nucleot（s）ide analogues could suppress HBV replication,improve liver function,stabilize or even reverse the development of decompensated cirrhosis and be well-tolerated.Further studies are needed to observe the long-term efficacy and the rate of liver cancer development.