拉米夫定联合糖皮质激素治疗慢性重型乙型肝炎临床分析

Clinical analysis of lamivudine combined with glucocorticoids in the treatment of chronic severe hepatitis B

目的探讨抗病毒药物拉米夫定联合糖皮质激素治疗慢性重型乙型肝炎的临床疗效。方法 80例慢性重型乙型肝炎患者随机分为观察组和对照组各40例,对照组给予拉米夫定及常规综合治疗,观察者在对照组基础上加用糖皮质激素,治疗8周后比较两组患者的临床效果。结果治疗8周后,两组患者血清总胆红素均显著降低,PTA均显著增高,与治疗前比较差异均有显著统计学意义(P<0.01),且治疗后比较,观察组血清总胆红素显著低于对照组,PTA显著高于对照组,差异均有显著统计学意义(P<0.01);观察组治疗前血清HBVDNA水平与治疗第8周结束时比较差异无统计学意义(P>0.05),同时治疗第8周结束时,两组血清HBVDNA转阴率比较差异也无统计学意义(P>0.05);观察组治疗失败率为12.5%,明显低于对照组的40.0%,住院时间也明显短于对照组,差异均有统计学意义(P<0.05)。两组患者治疗过程中均未出现严重不良反应。结论拉米夫定联合糖皮质激素治疗慢性重型乙型肝炎可有效抑制HBV病毒的持续复制,避免再生肝细胞的破坏,提高患者的生命质量,值得临床推广。

Objective To discuss the clinical effects of lamivudine combined with glucocorticoids in the treat-ment of chronic severe hepatitis B. Methods Eighty patients with chronic severe hepatitis B were randomly divided in-to the observation group and control group, with 40 patients in each group. The control group were treated with lamivu-dine and routine comprehensive treatment, and the observation group were given also glucocorticoids based on the con-trol group. Clinical effects of the two groups were compared after 8 weeks of the treatments. Results After 8 weeks of treatment, the total bilirubin was significantly reduced and PTA was significantly increased in both groups （P〈0.01）, while the total bilirubin was significantly lower and PTA was significantly higher in the observation group than those in the control group （P〈0.01）. There was no significantly difference in HBV DNA before or after the treatment in the observation group （P〉0.05）, and there was also no significantly difference in the negative rate of HBV DNA between the two groups 8 weeks after the treatment （P〉0.05）. The rate of treatment failure in the observation group was 12.5%（5/40）, which was significantly lower than 40.0%（16/40） in the control group （P〈0.05）. The hospitalization time of ob-servation group was significantly shorter than that of the control group （P〈0.05）. There was no serious adverse reac-tion during treatments in the two groups. Conclusion Lamivudine combined with glucocorticoid in the treatment of chronic severe hepatitis B can effectively inhibit the continuous replication of HBV virus, prevent damage of regener-ated of liver cell, and improve the quality of life of patients. It is therefore worthy of clinical promotion.