慢性乙型肝炎肝硬化失代偿抗病毒治疗探讨

The Discussion of Therapy of Decompensate and Antiretroviral in Chronic Hepatitis B Cirrhosis

目的探讨慢性乙型肝炎肝硬化失代偿期抗病毒治疗的临床疗效。方法将我院自2005年2月至2011年3月收治的慢性乙型肝炎失代偿期肝硬化患者89例分为对照组和观察组。对照组41例采用单独给予拉米夫定100mg/d治疗,观察组48例在对照组的基础上加用阿德福韦酯10mg/d,治疗24个月。观察比较两组治疗前后的肝功能指标(AST、ALT、TBiL、ALB)、HBV DNA及HBeAg阴转率、HBeAg/HBeAb血清转换率和病毒变异情况。结果治疗后观察组患者肝功能指标比对照组有明显改善(P<0.01);观察组患者HBVDNA及HBeAg阴转率、HBeAg/HBeAb血清转换率明显高于对照组(P<0.05);两组患者的病毒变异率无显著性差异(P>0.05)。结论拉米夫定联合阿德福韦酯治疗失代偿期肝硬化可有效延缓或阻止肝硬化的进一步发展、改善肝功能,并能稳定或改善失代偿期肝硬化;病毒变异率低,且无严重的不良反应,治疗效果良好。

Objective To investigate the clinical efficacy of therapy of decompensate and antiretroviral in chronic hepatitis B cirrhosis.Methods 89 cases with chronic hepatitis B cirrhosis in decompensate period were divided into control group and observation group from February 2005 to March 2011 in our hospital.41 cases in the control group were given lamivudine while 48 cases in the observation group were received 10mg/d of adefovir dipivoxil for 12 months on the basis of the control group.The liver function（AST,ALT,TBiL and ALB）,HBV DNA and the rate of HBeAg negative conversion,HBeAg/HBeAb conversion and virus variation were compared before and after treatment.Results After the treatment,liver function in the observation group improved better than which was in the control group（P0.01）;HBV DNA,the rate of HBeAg negative conversion and HBeAg/HBeAb conversion rate in the observation groups were significant higher than which were in the control group（P0.05）;there was no significant difference of viral mutation rate between the two groups（P0.05）.Conclusion Lamivudine combined with adefovir dipivoxil treating with the decompensated cirrhosis can effectively delay or prevent further development of cirrhosis of the liver and improve liver function and can stabilize or improve decompensated cirrhosis;the virus mutation rate is low,and has no serious adverse reaction.