拉米夫定和阿德福韦酯治疗乙型肝炎肝硬化失代偿期疗效观察

Observation of lamivudine and adefovir dipivoxilin treatment for hepatitis B with decompensated cirrhosis

目的观察拉米夫定、阿德福韦酯单药或联合治疗乙型肝炎肝硬化失代偿期的疗效。方法将96例乙型肝炎肝硬化失代偿期患者按数字表法随机分为3组，所有患者均给予基础治疗，此外分别给予拉米夫定100mg／d（LAM组），阿德福韦酯10mg／d（ADV组），拉米夫定（100mg／d）＋阿德福韦酯（10mg／d）（联合组），疗程均为48周。观察所有患者肝功能变化、HBV DNA、HBeAg阴转率以及Child-Pugh评分。结果治疗48周，三组患者ALT、白蛋白（ALB）、总胆红素（TBil）及Child-Pugh评分明显好转，治疗前后比较差异有统计学意义（t=2．21-20．40，P〈0．05），3组患者无一例死亡。治疗48周HBV DNA阴转率LAM组、ADV组和联合组分别为53．13％、43．75％、81．25％，联合组与LAM组及ADV组比较差异均有统计学意义（X^2=5．74、9．40，P〈0．05）。HBeAg阴转率LAM组、ADV组和联合组分别为15．79％、9．52％、40．91％，联合组明显高于单药组（X^2=4．94、7、73，P〈0．05）。此外，LAM组中有2例患者在治疗第36、48周发生YMDD变异。结论拉米夫定和阿德福韦酯联合或单药治疗均能有效改善乙型肝炎肝硬化失代偿期患者肝功能及Child-Pugh评分，联合治疗能更快速有效地抑制HBV DNA的复制，且病毒变异少。

Objective To observe lamivudine, adefovir dipivoxil montherapy or combined therapy for hepatitis B patients with decompensated cirrhosis. Methods 96 cases of hepatitis B patients with decompensated cirrhosis were randomly divided into 3 groups, all the patients were given basic treatment, then patients were respectively given lamivudine 1130 mg/d（LAM group）, adefovir dipivoxil i0 mg/d（ADV group）, lamivudine combined adefovir dipivoxil （combined group） for 48 weeks. The liver function, HBV DNA, HBeAg negative rate and Child-Pugh score were analysed. Results The ALT, ALB, TBil and Child-Pugh scores were improved after 48 weeks of treatment in 3 groups without death, and there were remarkable difference compared with pretreatment （ t = 2.21-20.40, P 〈 0.05）. HBV DNA negative conseration rate in LAM group, ADV group and combined group after 48 weeks＇ treatment were 53.13%, 43.75%, 81.25% respectively, the rates in LAM group and ADV group were significant lower than that in combined goup （X^2 = 5.74, 9.40, P 〈0.05）. HBeAg negative rate in LAM, ADV, combined groups were 15.79%, 9.52%, 40.91% respectively, and the rates in LAM group and ADV group were significant lower than that in combined group （ X^2 = 4.94, 7.73,P 〈 0.05）, 2 cases of YMDD mutation in LAM group were found.Conclusions Lamivudine and adefovir dipivoxil combined or montherapy can effectively improve the liver function and Child-Pugh score for hepatitis B with decompensated cirrbosis, combined treatment can suppress HBV DNA replication more quickly and effectively, and with less viral mutation.