替比夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化的临床研究

Clinical study on telbivudine combined with adefuvir dipivoxil in the treatment of Hepatitis B patients with decompensated cirrhosis

目的观察替比夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者的临床疗效。方法将失代偿期乙型肝炎肝硬化患者共56例，随机分成治疗组（30例）和对照组（26例），两组均予常规基础治疗，同时治疗组用替比夫定600mg联合阿德福韦酯胶囊10mg，1次／d，对照组单用阿德福韦酯胶囊10mg，1次／d。治疗24周时观察两组的疗效。结果治疗后，治疗组肝功能指标、Child．Pugh评分分别为（33．2±13．8）μmol／L、（44．5±16．4）U／L、（36．1±1．5）g／L、（6．1±1．8）分，均优于对照组的（71．8±18．6）μmol／L、（89．9±44．9）U／L、（29．7±1．3）g／L、（8．1±2．2）分（t=15．32，15．20，23．37，6．09，均P〈0．05）；治疗组HBV—DNA阴转率、HBeAg血清转换率分别为93．3％（28／30）、43．3％（13／30），均高于对照组的76．9％（20／26）、7．6％（2／26）（x^2=4．87，9．08，均P〈0．05）。结论对失代偿期乙型肝炎肝硬化患者采用替比夫定联合阿德福韦酯可以快速强效抑制病毒复制，改善症状及肝功能指标，从而延缓肝硬化的病理学进展。

Objective To observe the effect of telbivudine combined with adefuvir dipivoxil in the treatment of Hepatitis B patients with decompensated cirrhosis. Methods 56 Hepatitis B patients with deeompensated cirrhosis were divided into two groups：treatment group （30 cases） and control group （26 cases）. During 24 weeks, the control group received adefuvir dipivoxil（ 10rag daily）, supportive and symptomatic treatments, while the treatment group received telbivudine therapy（600mg daily） combiled with adefuvir dipivoxil （10mg daily） based on the regular treatments. After 24 weeks, the effect was observed and compared between the two groups. Results After treatment, the biochemical markers ,Child-Pugh score of the treatment group was （33.2 ± 13.8 ） μmol/L, （44.5± 16.4 ） U/L, （36. 1±1.5 ）g/L, （6. 1±1. 8） points, respectively, and was better than those of the control group [ （71.8 ± 18.6 ） μmol/L, （ 89.9± 44.9 ） U/L, （29.7 ± 1.3 ） g/L, （ 8.1 ±2.2 ） points ] （ t = 15.32,15.20,23.37,6.09, all P 〈 0. 05） ;HBV-DNA negative rate, HBeAg seroconversion rates of the treatment group was 93.3% （28/30） ,43.3% （13/30）, and was higher than that of the control group[76.9% （20/26） ,7.6% （2/26） ] （ X2 = 4.87,9.08, all P 〈 0.05 ）. Conclusion Telbivudine combined with adefuvir dipivoxil was effective and safe for the treatment of Hepatitis B patients with decompensated cirrhosis.