老年乙肝后肝硬化失代偿期患者应用拉米夫定联合前列腺素E治疗的效果观察

Clinical efficacy of lamivudine combined with prostaglandin E in treatment of elderly patients with decompensated liver cirrhosis

[目的]探讨老年乙肝后肝硬化失代偿期患者应用拉米夫定联合前列腺素E治疗的临床疗效。[方法]选取我院102例老年乙肝后肝硬化失代偿期患者,采用完全随机化原则将其分为2组,每组各51例,其中对照组患者采用拉米夫定等常规药物治疗,观察组在此基础上给予前列腺素E治疗。观察比较2组患者治疗前后谷丙转氨酶、谷草转氨酶、血清总胆红素、白蛋白、临床疗效及不良反应发生情况。[结果]2组患者治疗前谷丙转氨酶、谷草转氨酶、血清总胆红素、白蛋白比较,差异均无统计学意义(P>0.05)。治疗后,对照组患者谷丙转氨酶为(90.4±12.2)U/L,明显低于治疗前[(249.8±52.6)U/L,t=21.082,P<0.05];谷草转氨酶为(89.6±11.7)U/L,明显低于治疗前[(279.6±66.1)U/L,t=20.213,P<0.05];血清总胆红素为(47.9±13.8)μmol/L,明显低于治疗前[(72.6±18.2)μmol/L,t=7.723,P<0.05];白蛋白为(30.3±5.9)g/L,明显高于治疗前[(23.8±5.2)g/L,t=-5.902,P<0.05]。治疗后,观察组患者谷丙转氨酶为(57.8±7.7)U/L,明显低于治疗前[(253.2±53.3)U/L,t=25.912,P<0.05];谷草转氨酶为(46.2±6.0)U/L,明显低于治疗前[(280.5±67.2)U/L,t=24.801,P<0.05];血清总胆红素为(28.5±8.1)μmol/L,明显低于治疗前[(72.9±18.0)μmol/L,t=16.064,P<0.05];白蛋白为(33.1±6.2)g/L,明显高于治疗前[(23.4±5.0)g/L,t=-8.697,P<0.05]。且观察组以上指标改善幅度均高于对照组,差异有统计学意义(t=16.137,23.572,8.658,-2.336,P<0.05)。观察组总有效率为58.8%,明显高于对照组31.4%,差异有统计学意义(!2=7.761,P<0.01)。观察组患者无严重不良反应发生,对照组出现3例腹胀腹泻患者,差异无统计学意义(!2=3.091,P>0.05)。[结论]老年乙肝后肝硬化失代偿期患者应用拉米夫定联合前列腺素E治疗可明显改善肝功能,提高临床疗效,且具有较高的安全性,值得应用推广于临床。

[Objective]To investigate the clinical efficacy of lamivudine combined with prostaglandin E in treatment of elderly patients with decompensated liver cirrhosis. [Methods] 102 elderly patients with de-compensated liver cirrhosis after hepatitis B in our hospital were chosen,who were divided into two groups by completely random principle, 51 cases in each group. The patients in control group were treated with lamivudine and other conventional drug treatment, while the patients in observation group were treated with prostaglandin E on the base of control group. The levels of alanine aminotransferase,aspartate amin- otransferase,serum total bilirubin and albumin, clinical efficacy and adverse events were compared before and after treatment. [Results]The differences of levels of alanine aminotransferase, aspartate aminotrans-ferase, serum total bilirubin and albumin in two groups before treatment were not statistically significant（P〉0.05）. In the control group,the levels of alanine aminotransferase[（90.4±12.2）U/L vs. （249.8±52.6）U/L, t=21. 082, P〈0.05 ], aspartate aminotransferase [ （ 89.6 ± 11.7 ） U/L vs. （ 279.6 ± 66.1 ） U/L, t =20. 213,P〈0.05], serum total bilirubin[（47.9±13.8）μmol/L vs. （72.6±18.2） μmol/L,t = 7. 723,P〈 0.05]after treatment were lower than before treatment,albumin[（30.3±5.9）g/L vs. （23.8±5.2）g/L,t=-5.902 ,P〈0. 05]after treatment was higher than before treatment. In the observation group,the levels of alanine aminotransferase[（57.8± 7.7） U/L vs. （253.2± 53.3） U/L, t=25. 912, P〈0.05], aspartate amin- otransferase[（46.2± 6.0） U/L vs. （280.5 ± 67.2） U/L, t=24. 801, P〈0.05], serum total bilirubin[-（28.5±8.1） μmol/L vs. （72.9 ±18.0）μmol/L, t=16. 064, P〈0.05] after treatment were lower than before treatment,albumin[-（33.1±6.2）g/L vs. （23.4±5.0）g/L,t=-8. 697,P〈0.05]after treatment was higher than before treatment. Also, the magnitude of improvement of all the index above in the observation group were higher than those in control group, the differences were statistically significant（t=-16. 137, 23. 572,8. 658, --2. 336 ,P〈0.05）. The total effective rate of observation group was 58.8% ,which was sig- nificantly higher than that in control group with 31.4%,the difference was statistically significant（χ^2=7. 761 ,P=0.005）. There was no serious adverse events in the observation group, while had three cases of patients with diarrhea, abdominal distension in control group, the difference was not statistically significant （χ^2= 3.091, P= 0.079）. [Conclusion]The lamivudine combined with prostaglandin E in treatment of elderly patients with decompensated liver cirrhosis therapy can significantly improve liver function,improve the clinical efficacy,and with a high safety. It is worthy to promote the application in clinical practice.