阿德福韦酯联合拉米夫定治疗乙肝肝硬化失代偿期的疗效及安全性评价

Evaluation on efficacy and safety of adefovir dipivoxil combined with lamivudine treatment for hepatitis B virus-related decompensated cirrhosis patients

目的探讨阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿期的疗效与安全性。方法将214例乙型肝炎肝硬化失代偿期患者随机分为A、B、C组,分别为70、72、72例。各组均给予常规护肝及抗纤维化对症治疗,A组在此基础上联合使用阿德福韦酯(10 mg/d)、拉米夫定(100 mg/d)治疗,B组在常规治疗基础上予阿德福韦酯(10 mg/d)治疗,C组为对照组,观察并对比不同组别患者肝肾功能、血清HBV DNA阴转率、HBeAg转阴率、凝血酶原时间、肝脏Child-pugh评分及药物不良反应。结果①治疗24、48周时,各项指标改善程度A组>B组>C组,差异均具有统计学意义(P<0.05);②A、B、C三组治疗过程中死亡例数分别为2、4、8例。其余病例未见严重不良反应。结论阿德福韦酯与拉米夫定均为抗乙肝病毒的理想药物,二者联合治疗乙肝肝硬化失代偿期患者可增加抗病毒效果,明显改善患者预后。

Objective To explore the clinical effect and safety of adefovir dipivoxil（ADV）combined with lamivudine（LAM）in treatment for patients with hepatitis B virus-related decompensated cirrhosis.Methods 214 admitted patients were randomized into group A,group B,group C with 70,72,72 cases in each group.Group C（control group）was given conventional hepatic and symptomatic treatment,based on which,treatment schedule of group A was added ADV and LAM,and group B was added ADV.Liver-kidney function,HBV DNA negative conversion rate,HBeAg negative conversion rate,PT,liver Child-pugh grade,adverse drug reactions were observed and compared between different groups.Results ①Sequence of improvement of different groups in terms of observational indexes after 1-2 treatment course was group Agroup Bgroup C,and there was statistical difference（P0.05）.②Adverse drug effects was rarely seen in three groups,the number of death cases of A,B,C group was 2,4,8 respectively.Conclusion ADV combined with LAM treatment for decompensated hepatitis B related cirrhosis can widely improve the anti-viral effect,and it has favourable safety and clinical efficacy.