乙型肝炎肝硬化失代偿期患者应用核苷类药物临床观察

CLINICAL OBSERVATIONS ON THE THERAPEUTIC EFFECT OF NUCLEOSIDE DRUGS IN TREATMENT OF HEPATITIS B VIRUS RELATED DECOMPENSATED LIVER CIRRHOSIS

目的探讨不同核苷类药物对乙型肝炎肝硬化失代偿期患者肝功能、病毒学及并发症的影响。方法选取该院消化内科2010年1月—2015年12月收治的乙型肝炎肝硬化失代偿期患者87例。按照患者选择服用的核苷类药物分为拉米夫定组23例,阿德福韦酯组39例,恩替卡韦组25例。随访3年,记录三组患者治疗前及治疗后3年的肝功能、HBV DNA水平及并发症发生情况。结果治疗前三组患者的肝功能、HBV-DNA载量、腹腔积液的发生率、自发性腹膜炎的发生率、肝性脑病的发生率差异无统计学意义(P>0.05)。治疗后三组患者肝功能均有所改善,且恩替卡韦组肝功能各项指标较其他二组明显下降,差异有统计学意义(P<0.05)。治疗后三组患者HBV-DNA载量均较前降低,且恩替卡韦组较其他二组明显下降,差异有统计学意义(P<0.05)。治疗后三组患者腹腔积液、自发性腹膜炎、肝性脑病的发生率均较前降低,但三组比较差异无统计学意义。结论核苷类抗病毒药物治疗乙型肝炎肝硬化能够明显改善肝功能,降低HBV-DNA载量,减少并发症的发生,其中恩替卡韦临床效果优于拉米夫定及阿德福韦酯,疗效较为突出。

Objective To explore the effects of nucleoside drugs treatment on liver function ,virology and complications in hepatitis B virus related decompensated liver cirrhosis .Methods Totally 87 cases of pa‐tients with hepatitis B virus related decompensated liver cirrhosis in department of Gastroenterology from January 2010 to December 2015 were enrolled .According to antiviral medicine ,they were divided into Lamivudine（LAM） group （n=23） ,Adefovir（ADV） group （n=39） ,Entecavir（ETV） group （n=25） . Liver function ,the level of HBV DNA and complications of liver cirrhosis were documented before treat‐ment and three years after treatment .Results There was no significant difference among the three groups （P〉0 .05） in liver function ,the level of HBV DNA and the incidences of ascites ,spontaneous peritonitis and hepatic encephalophathy before treatment . The liver function were improved after treatment in all groups ,expecially in Entecavir（ETV） group .As compared with the other two groups ,the difference was statistically significant （P〈0 .05） .The level of HBV DNA were decreased after treatment in all groups , expecially in Entecavir（ETV） group .As compared with the other two groups ,the difference was statisti‐cally significant （P〈0 .05） .The incidences of ascites ,spontaneous peritonitis and hepatic encephalophathy were decreased after treatment in all groups .But there was no difference among them .Conclusions Nucle‐oside antiviral drug treatment of hepatitis B virus related decompensated liver cirrhosis can significantly im‐prove the liver function ,reduce HBV -DNA level and the incidences of complications ,with Entecavir clini‐cal effect is superior to Lamivudine and Adefovir .It has remarkable curative effect.