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观察

Observation of the effecacy of adefovir dipivoxil combined with lamivudine on patients with decompensate HBV cirrhosis

目的探讨阿德福韦酯联合拉米夫定在乙肝肝硬化失代偿期病人治疗中的临床效果。方法将93例乙肝肝硬化失代偿期患者随机分为两组,对照组45例给予常规保肝、对症处理及服用阿德福韦酯治疗,观察组48例在此基础上加服拉米夫定治疗,两组疗程均为12个月。观察治疗前及治疗后两组患者肝功能[谷丙转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、血清白蛋白(ALB)、总胆红素(TBiL)]及肝脏Child-pugh评分变化情况,检查HBV-DNA定量,记录治疗过程中的不良反应。结果经治疗后观察组的ALT、AST、ALB、TBiL等肝功能指标的改善均明显优于对照组(P<0.05或<0.01);观察组HBV-DNA阴转率为82.4%(40/48),对照组的阴转率为62.2%(28/45),两组阴转率比较差异有统计学意义(P<0.05);经治疗后观察组HBV-DNA水平、Child-Pugh分级评分改善均明显优于对照组(P<0.01);两组均未发生不可耐受的并发症。结论阿德福韦酯联合拉米夫定用于乙肝肝硬化失代偿期能增加抗病毒治疗效果,明显改善患者肝功能,且安全性较高。

Objective To investigate the effecacy of adefovir dipivoxil combined with lamivudine for treating patients with decompensate HBV cirrhosis. Methods 93 patients with decompensate HBV cirrhosis were randomly divided into the observation group（48 cases） and the control group（45 cases）.The control group was given conventional liver protection, symptomatic treatment and adefovir dipivoxil.Based on the above treatment,lamivudine was added to the observation group. Both groups were treated for 12 months.Then, the liver function inclu- ding alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, serum albumin （ALB）, total bilirubin （TBiL） and the change of liver Child-pugh scoring of both groups before and after treatment were observed.Mean- while, their HBV-DNA quantification was tested and adverse reactions during treatment were recorded.Results After treatment,improvement of the observation group in levels of ALT, AST, ALB and TBiL was significantly better than that of the control group（ P 〈0.05 or 〈0.01）.The HBV-DNA negative-converting rate of the obser- vation group was 82.4 % （40/48）and that of the control group was 62.2 % （28/45）, so their difference was statistically significant（ P d0.05）.The observation group had more significant improvement in HBV DNA level and Child-Pugh scoring than the control group after treatment（ P 〈0.01）.Both groups did not have intolerable complications.Conclusion Adefovir dipivoxil combined with lamivudine for patients with decompensate HBV cirrhosis can widely improve the anti-virus effect and significantly improve patients＇ liver function with high safety.