替比夫定联合阿德福韦酯与恩替卡韦单药治疗失代偿期乙型肝炎肝硬化疗效比较

Comparison on Effect between Telbivudine Combined with Adefovir and Entecavir in Treatment of Patients with Hepatitis B Virus-related Decompensated Cirrhosis

目的比较阿德福韦酯(ADV)与替比夫定(LDT)初始联合与恩替卡韦(ETV)单药治疗失代偿期乙型肝炎肝硬化患者的安全性及疗效,找到更有效更安全的治疗方法。方法:将符合标准的86例失代偿期乙型肝炎肝硬化患者随机分成联合用药组和单独用药组,联合用药组服用阿德福韦酯及替比夫定,单独用药组服用恩替卡韦,每组43例,治疗疗程为48周,记录不同时间两组肝功能、肾功能、出凝血时间、HBV DNA定量的变化、CTP评分和MELD评分,并进行组间比较。结果:联合治疗组和单药组在治疗第24周、48周时ALT复常两组差异均无统计学意义,治疗第24周、48周时,HBeAg阴转例数两组差异有统计学意义,治疗第24周、48周时,两组HBV DNA低于检测值的例数差异无统计学意义。结论:LDT与ADV初始联合更适用于临床,且联合组HBeAg血清学转换率高于单药组,具有统计学意义。

Objective To compare the efficiency and safety of adefovir in combination with telbivudine with entecavir（ETV） monotherapy in treatment of patients with hepatitis B virus（HBV）-related decompensated liver cirrhosis （LC）. Methods 86 cases of patients with decompensated LC were divided randomly into two groups ,telbivudine in combinationwith adefovir group and enteeavir group. During the 96-week observation, the hepatic function,renal function ,bleeding-time and clotting-time, Child-Pugh scores and HBV-DNA level in both groups were recorded. Results There was no significant difference in ALT normalization rate at 24 weeks and 48 weeks between the two groups; while HBeAg seroconversion rate in LAM ＋ ADV group at 48 weeks was significantly higher than that in ETV group. There was no significant difference in HBV DNA negative rate at 24weeks and 48 weeks. Conclusion LDT ＋ ADV combination therapy has more effective inhibition on HBV replication than ETV, and the HBeAg seroconversion rate in combination therapy group is higher than that in monotherapy group ,so the combination therapy is more suitablefor clinical therapy.