乙型肝炎肝硬化失代偿期初始拉米夫定和阿德福韦酯联合抗病毒治疗的疗效观察

The evaluation of de novo combination of antiviral treatment to hepatitis B patients with decompensated cirrhosis

目的研究拉米夫定(LAM)初始联合阿德福韦酯(ADV)治疗乙型肝炎肝硬化失代偿期患者的疗效与安全性。方法 30例HBeAg阳性乙型肝炎肝硬化失代偿期患者,分为LAM初始联合ADV治疗组和变异后联合组,疗程均为48周。结果初始联合组与变异后联合组患者ALT与TBil在治疗4、12、24与48周均较基线明显好转(P<0.05),治疗4、12周后,两组均无HBV DNA转阴的患者,治疗24周后,分别有4例(40%)初始联合组与4例(20%)变异后联合组患者HBV DNA转阴,但差异无统计学意义。治疗48周后,初始联合组与变异后联合组HBV DNA转阴率分别为90%(9/10)与40%(8/20),HBeAg/抗-HBe血清转换率分别为60%(6/10)与20%(4/20),两组间差异均具有统计学意义(P<0.05)。初始联合组患者Child-Pugh评分在48周时,优于变异后联合组(P<0.05)。结论 ADV初始联合LAM治疗在改善乙型肝炎肝硬化失代偿期患者临床状况及抗病毒方面均明显优于变异后联合治疗。

Objective To evaluate the efficacy and safety of de novo combination therapy with lamivudine and adefovir dipivoxil in the treatment patients of chronic hepatitis B with decompensated cirrhosis. Methods Thirty chronic hepatitis B patients with decompensated cirrhosis were enrolled in and divided into two groups, one group （10 patients） was given lamivudine combined with adefovir dipivoxil at the beginning of the therapy, while the other group （ control group） was given lamivudine only at the beginning of treatment, then added adefovir dipivoxil on after HBV YMDD mutation. The duration of treatment for both groups was 48 weeks. Results The ALT and TBil levels in these groups were improved after 4, 12, 24, and 48 treatment weeks （ P 〈 O. 05 ）. No patient achieved HBV DNA undetectable in these groups after4 and 12 weeks treatment. However, after 24 weeks treatment, 4 in denovo combination group （40%） and 4 in added-on group （20%） achieved HBV DNA undetectable, respectively （P =0.384）. The undetectable rates of HBV DNA at week 48 were 90% for the denovo combination group and 40% for the controls （ P 〈 0.05 ）. The rates of HBeAg/HBeAb seroconversion were 60% and 20% （ P 〈 0. 05）, respectively for the denovo combination group and the control. After 48 weeks treatment, Child - Pugh scores in the denovo combination group was better than that in the control group （P 〈 0.05）. Conclusion Lamivudine combined with adefovir dipivoxil at the beginning of the therapy was effective in improving liver function, antiviral effect and Child - Pugh score in chronic hepatitis B with decompensated cirrhosis patients.