恩替卡韦与拉米夫定治疗乙型肝炎失代偿性肝硬化临床观察

Clinical study on treatment of Entecavir versus Lamivudine in patients with decompensated HBV-related cirrhrosis

目的探讨恩替卡韦治疗乙型肝炎失代偿性肝硬化(DLC)患者的临床疗效和安全性。方法 63例Child-PughB级乙型肝炎DLC患者在综合治疗的基础上,分为恩替卡韦治疗组30例(给予恩替卡韦0.5 mg口服,1次/d)和拉米夫定对照组33例(给予拉米夫定100 mg口服,1次/d),疗程均在48周以上。在治疗开始前、开始后1、12、24、48周分别检测血清乙肝病毒定量(HBV DNA)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)、肝肾功能、凝血功能、血清肌酐(SCr)、血常规和Child-Turcotte-Pugh分级(CPT评分)等指标。结果恩替卡韦组有24例、拉米夫定组30例已完成48周治疗。恩替卡韦组治疗失代偿性乙型肝炎肝硬化与拉米夫定组疗效相似。拉米夫定组有7例出现耐药加用阿德福韦酯联合治疗,恩替卡韦组无1例发生耐药。恩替卡韦组2例、拉米夫定组3例发生原发性肝癌。结论恩替卡韦治疗乙型肝炎DLC1年临床疗效较明显,无耐药发生,是乙型肝炎DLC抗病毒治疗的有效药物。

Objective To explore clinical efficacy and safety of Entecavir in treating decom- pensated cirrhrosis. Methods Sixty - three patients with decompensated cirrhosis in Child - Pugh B were divided into two groups voluntarily, with 30 and 33 patients respectively. Entecavir 0.5 mg/ d was applied in the treatment group and Lamivudine 100 mg/d in the control group on the basis of general treatment. Before and at 1st, 12th, 24th and 48th week after antivirus treatment, the fol- lowing data were obtained including blood cell counts（WBC, RBC, PLT）, liver function（ALT, AST, TBiL,ALB）, PTA, level of HBV DNA, HbeAg, HbeAb, serum creatinine（Cr）, and child - Pugh Tureotte（CPT）as well. Results Twenty - four patients among Entecavir group and 30 a- mong Lamivudine group completed the therapeutic course of 48 weeks. Entecavir showed similar ef- ficacy with Lamivudine in treatment of decompensated cirrhrosis. The treatment has been adjusted to Adefovir and Lamivudine in 7 of the 30 patients of the control group for Lamivudine resistance. No evidence of Entecavir resistanc was found. Primary hepatocarcinoma occurred, 2 from Entecavir group and 3 from Lamivudine group. Conclusion It is effective to treat the decompensated cirrhro- sis patients with Enteeavir for one year, and the patients presented good tolerability but no drug re- sistance. Entecavir is an effective drug in treatment of decompensated eirrhrosis.