三种抗病毒方案治疗失代偿期乙型肝炎肝硬化的疗效观察

Therapeutic Effects of Three Kinds of Antiviral Regimens on Treatment of Patients with HBV Related Decompensated Cirrhosis

目的:比较替比夫定、恩替卡韦及拉米夫定联合阿德福韦酯对失代偿期乙型肝炎肝硬化患者的临床疗效。方法:回顾性分析2009年1月-2012年1月在本院住院的85例失代偿期乙型肝炎肝硬化初次患者的临床资料,根据采用不同抗病毒方案分为单药替比夫定(Ld T)组(29例)、单药恩替卡韦(ETV)组(30例)及拉米夫定联合阿德福韦酯(LAM+ADV)组(26例)。抗病毒治疗96周以上,比较3组失代偿期乙型肝炎肝硬化患者治疗后12、24、96周丙氨酸氨基转移酶(ALT)复常率和乙肝病毒DNA(HBV DNA)转阴率,治疗后96周乙型肝炎E抗原(HBe Ag)转阴率及转换率、HBV耐药率及Child-Pugh分级变化情况等。结果:所有患者均完成96周以上的抗病毒治疗。3组治疗后第12周、24周及96周ALT复常率差异和HBV DNA转阴率差异均无统计学意义。治疗后第96周Ld T组HBe Ag转阴率为42.9%,高于ETV组的22.7%和LAM+ADV组的20.0%,Ld T组HBe Ag血清转换率为28.6%,也高于ETV组的13.6%和LAM+ADV组的15.0%,但3组患者差异无统计学意义;3组患者耐药情况比较,差异无统计学意义;与治疗前比较,3组患者治疗后Child-Pugh分级均有改善,差异具有统计学意义,但3组治疗后组间比较,差异无统计学意义。结论:3种抗病毒方案治疗失代偿期乙型肝炎肝硬化可有效抑制患者HBV DNA复制和改善肝功能,Ld T组在HBe Ag转阴率和转换率上可能优于另两组,3组其他临床疗效相当。

Objective To compare the clinical effects of three kinds of antiviral regimens with telbivudine,entecavir or lamivudine combined with adefovir in patients with HBV related decompensated cirrhosis.Methods The clinical data of 85 patients with hepatitis B-induced decompensated liver cirrhosis hospitalized in our hospital from January 2009 to January 2012 were retrospectively analyzed.The patients were divided into telbivudine（ Ld T） group（ n = 29）,entecavir（ ETV） group（ n =30） and lamivudine combined with adefovir（ LAM ADV） group（ n = 26） according to the different antiviral regimens.After treating for more than 96 weeks,the recovery rates of alanine aminotransferase（ ALT） and negative rate of HBV DNA at12,24 and 96 week,the negative rate and the conversion rate of hepatitis B e antigen（ HBe Ag）,the rate of drug resistance and Child-Pugh grading changes at 96 week were compared among three groups.Results All patients were treated with antiviral therapy for more than 96 weeks.The differences of the recovery rates of ALT and negative rate of HBV DNA had no significant difference among three groups at 12,24 and 96 week.The negative rate of HBe Ag was 42.9% in Ld T group,which was significantly higher than 22.7% in ETV group and 20.0% in LAM ADV group,the conversion rate of HBe Ag in the Ld T group was 28.6%,which was significantly higher than 22.7% in ETV group and 20.0% in LAM ADV group,but the differences among three groups had no significance（ P = 0. 216,0. 415,respectively）. There was no significant difference in drug resistance among the three groups. After treatment,Child-Pugh gradings of the three groups were significanctly improved than each of them before treatment,but which had no significant difference among the three groups after treatment.Conclusion The three kinds of antiviral regimens could effectively inhibit HBV DNA replication and improve liver function in the treatment of HBV related decompensated cirrhosis,the telbivudine group may be better in improving HBe Ag negative rate and conversion rate than the other two groups,but the other clinical efficacy of the three groups were similar.