替比夫定联合阿德福韦酯长期治疗活动性乙型肝炎肝硬化的临床观察

Clinical Observation of Telbivudine Combined with Adefovir Dipivoxil in Long-term Treatment of Active Hepatitis B Cirrhosis

目的:观察替比夫定联合阿德福韦酯长期治疗活动性乙型肝炎肝硬化的疗效及安全性。方法:76例活动性乙型肝炎肝硬化患者,按随机数字表法分为观察组和对照组,各38例。对照组患者给予阿德福韦酯10 mg,qd;观察组患者在对照组基础上加用替比夫定600 mg,qd。两组患者均连续服用2年。观察两组患者治疗后血清胆红素(TBIL)、白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乙型肝炎病毒的脱氧核糖核酸(HBV-DNA)转阴率、血清病毒学指标,并比较两组患者的临床疗效及不良反应。结果:治疗后,观察组患者的AST、ALB、ALT、TBIL水平均显著优于对照组,两组比较差异有统计学意义(P<0.05);观察组患者治疗后1、2年HBV-DNA病毒转阴率、血清病毒下降幅度均显著高于对照组,两组比较差异有统计学意义(P<0.05);观察组患者的临床总有效率显著高于对照组,两组比较差异有统计学意义(P<0.05);两组患者均未见明显不良反应发生。结论:替比夫定联合阿德福韦酯可以显著地改善乙型肝炎肝硬化患者肝功能水平,长期疗效良好,且安全性高。

OBJECTIVE：To observe therapeutic efficacy and safety of telbivudine combined with adefovir dipivoxil in long-term treatment of active hepatitis B cirrhosis. METHODS：76 patients with active hepatitis B cirrhosis in our hospital were randomly divided into observation group and control group,with 38 cases in each group. Control group was treated with adefovir dipivoxil 10 mg,qd;observation group was additionally treated with telbivudine 600 mg,qd,on the basis of control group. Both groups received 2-year consecutive treatment. TBIL,ALB,ALT,AST,rate of HBV-DNA negative conversion and serum virological index were compared between 2 groups after treatment,and clinical efficacy and ADR were also compared between 2 groups.RESULTS：After treatment,the levels of AST,ALB,ALT and TBIL in observation group were significantly better than the control group,with statistical significance（P〈0.05）;the rate of HBV-DNA negative conversion,the decreased of serum virus in observation group were significantly higher than control group after 1 and 2 years treatment,with statistical significance（P〈0.05）. The total effective rate of observation group was significantly higher than that of control group,with statistically significance（P〈0.05）.No obvious ADR was found in 2 groups. CONCLUSIONS：Telbivudine combined with adefovir dipivoxil can significantly improve the liver function of patients with hepatitis B cirrhosis and have good long-term therapeutic efficacy with high safety.