拉米夫定与阿德福韦酯初始联合或拉米夫定对乙型肝炎肝硬化患者血清生化指标影响比较

Comparison of Effect of Lamivudine and Adefovir Combination / Lamivudine on Serum Biochemical Indexes in Patients with Hepatitis B Cirrhosis

目的 比较拉米夫定与阿德福韦酯初始联合或拉米夫定对乙型肝炎肝硬化患者血清生化指标的影响及临床疗效。方法 选择2013年1月至2015年1月在成都医学院第一附属医院进行治疗的乙型肝炎患者80例,按照抽签法随机分为联合用药组（拉米夫定与阿德福韦酯初始联合治疗,给药量分别为100 mg/d和10 mg/d）和单独用药组（拉米夫定治疗,100 mg/d）,各40例。对两组患者治疗前后的肝功能生化指标、乙型肝炎病毒（HBV）DNA含量、HBV拷贝数监测。结果 治疗后单独用药组和初始联合用药组患者于肝功能相关的生化指标丙氨酸转氨酶（ALT）、总胆红素（TBIL）和白蛋白（ALB）,差异均无统计学意义[（42±14）U/L比（40±11）U/L;（27±12）μmol/L比（25±11）μmol/L;（35±4）g/L比（35±5）g/L]（P〉0.05）。治疗6个月时单独用药组HBV DNA转阴率、ALT复常率显著低于初始联合用药组[57.5%（23/40）比87.5%（35/40）,67.5%（27/40）比95.0%（38/40）],差异有统计学意义（P〈0.05）。两组患者HBV DNA拷贝数在治疗后6个月,治疗后12个月较治疗前呈现递减的趋势[单独用药组：（1.9±0.3）×106拷贝/L、（0.9±0.4）×106拷贝/L比（5.1±1.1）×106拷贝/L;初始联合组：（1.3±0.5）×106拷贝/L、（0.8±0.3）×106拷贝/L比（5.3±1.0）×106拷贝/L],两组在不同时点间差异有统计学意义（P〈0.05）。结论 拉米夫定与阿德福韦酯初始联合给药治疗乙型肝炎肝硬化与拉米夫定单独给药治疗乙型肝炎肝硬化对患者血清生化指标影响基本一致。但联合给药起效较早,能够更好地抑制HBV的复制,临床治疗疗效更佳。

Objective To investigate the effect of lamivudine and adefovir serum biochemical indexes and the clinical curative effect for patients with hepatitis B cirrhosis. Methods Total of 80 patients with hepatitis B cirrhosis treated in First Affiliated Hospital of Chengdu Medical College from Jan. 2013 to Jan. 2015 were included in the study and divided into combination drug group receiving lamivudine and adefovir therapy （ 100 mg/d and 10 rag/d） and single drug group receiving lamivudine therapy （100 mg/d） according to the lottery method ,40 cases in each group. The liver function index, HBV DNA content and HBV copies of the two groups were monitored. Results The difference of liver function related biochemical indexes including alanine aminotransferase （ ALT ） [ （42 ± 14 ） U/L vs （40 ± 11 ） U/L ], total bilirubin（TBIL） [ （27 ±12） μmol/L vs （25 ± 11 ） μmol/L], albumin（ALB） [ （35 ± 4） g/L vs （35 ±5） g/L] had no statistical significance （P 〉0.05） between single drug group and combination drug group after treatment. After 6 months, the HBV DNA negative rate and ALT normalization in the single drug group was significantly lower than the combination drug group [ 57.5% （23/40） vs 87.5% （35/40）, 67.5% （27/40） vs 95.0% （38/40） ] ,the differences were statistically significant（P 〈0. 05）. HBV DNA copy number after 6 months and 12 months of treatment of beth groups showed a decreasing trend[ single drug group：（ 1.9 ± 0. 3 ） ×10^6 copy/L, （0. 9 ± 0. 4 ）×10^6 copy /L vs （5. 1 ± 1.1 ） ×10^6 copy/L; combined treatment group：（1.3 ±0.5） ×10^6 copy/L,（0. 8 ±0.3） ×10^6copy/L vs （5.3 ±1.0） ×10^6 copy/L], the differences at different time points of the two groups were statistically significant（ P 〈 0. 05 ）. Conclusion Lamivudine and adefovir combined drug treatment has similar influence on serum biochemical indexes of patients with hepatitis B cirrhosis to the single lamivudine treatment,but the combination treatment has earlier onset,which can better inhibit the replication of HBV and has better curative effect.