阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿

目的观察并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病人的疗效与药物安全性。方法将102例乙型肝炎肝硬化失代偿期患者随机分为A、B两组,A组50例,B组52例,2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(10mg/d)、拉米夫定(100mg/d)治疗,B组在常规基础上予阿德福韦酯(10mg/d)治疗,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评分与药物不良反应。结果治疗48周时各项指标改善程度A组优于B组,A组HBV-DNA阴转率达53.5%,B组为33.9%,差异有统计学意义(P<0.05)。A组HBeAg血清转换率达31.6%,B组为21.8%,差异有统计学意义(P<0.05)。A组的CTP评分较B组下降明显(P<0.05)。A、B两组治疗过程中死亡例数分别为1、2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是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,能明显改善患者预后。

Objective To observe and explore the clinical effect and security of adefovir dipivoxil （ADV） combined with lamivudine （LAM） in treatment of patients with hepatitis B virus-related decompensated cirrhosis. Methods 102 admitted patients were randomized into group A／B, and each group included 50／52 cases respectively, treatment schedule of group A was added ADV and LAM,and group B was added ADV, liver-kidney functionkHBV DNA negative conversion ratekHBeAg negative conversion rate ／PT／liver Child-pugh grade／side reaction were observed and compared between different groups. Results Sequence of improvement of different group in terms of observational indexes after 48 weeks treatment course is group A 〉 group B, The HBVDNA negative rates in ADV combined with LAM de novo group and ADV group are 53.5% and 33.9% respectively. There is significant difference between them （P〈0.05）. The HBeAg negative rates in ADV and LAM group and ADV group are 31.6% and 21.8% respectively. There is significant difference between them （P〈0.05）. Improvement of liver function is more obviously in de novo combination group. There is significant difference between two groups （P〈0.05）. Side effects are rarely seen in two groups and death cases of Akl3 group were 1／2. Conclusion ADV combined with LAM in treatment of decompensated hepatitis B related cirrhosis can widely reduce viral load, and has favourable security and fine clinical effect.