拉米夫定联合阿德福韦酯治疗慢性乙型病毒性肝炎的临床疗效与安全性及成本效果分析

Clinical efficacy, safety and cost-effectiveness analysis of ramivudine combined with adefovir dipivoxil in the treatment of chronic viral hepatitis B

目的分析拉米夫定联合阿德福韦酯治疗慢性乙型病毒性肝炎(CHB)的临床效果、不良反应及成本效果。方法选择2015年1月-2018年10月三亚中心医院/海南省第三人民医院、海南医学院第二附属医院、三亚市人民医院收治的CHB患者80例,根据患者治疗药物不同分为A组和B组各40例。A组采用拉米夫定联合阿德福韦酯治疗,B组采用恩替卡韦治疗,比较2组临床疗效、治疗前后肝功能指标、HBV-DNA及不良反应发生情况,并对2组成本效果进行分析。结果 A组总有效率(97.50%)高于B组(80.00%),差异有统计学意义(χ2=4.035,P=0.023)。治疗后2组总胆红素(TBIL)、HBV-DNA、天门冬氨酸氨基转移酶(AST)低于治疗前,白蛋白(ALB)高于治疗前,且A组优于B组,差异均有统计学意义(P <0.01)。A组不良反应总发生率(7.50%)低于B组(22.50%),差异有统计学意义(χ2=4.117,P=0.024)。A组的成本效果优于B组。结论拉米夫定联合阿德福韦酯治疗CHB效果较好,安全性高,成本低。

Objective To analyze the clinical effects,adverse reactions and cost effects of lamivudine combined with adefovir dipivoxil in the treatment of chronic viral hepatitis B( CHB). Methods 80 CHB patients admitted to Sanya Central Hospital,the Second Affiliated Hospital of Hainan Medical College,and Sanya People’ s Hospital from January 2015 to October 2018 were selected. According to different treatment drugs,the patients were divided into group A and group B with40 cases each. Lamivudine combined with adefovir dipivoxil was used in group A,entecavir was used in group B. The clinical efficacy,liver function indexes,HBV-DNA and adverse reactions of the 2 groups were compared before and after treatment,and the effects of the 2 components were analyzed. Results Group A total effective rate( 97. 50%) was higher than group B( 80. 00%),the difference was statistically significant( χ~2= 4. 035,P = 0. 023). Two groups after treatment of total bilirubin( TBIL) 、HBV-DNA,aspartate amino transferase( AST) were lower than before the treatment,albumin( ALB) was higher than before the treatment,and group A was better than that of group B,the difference had statistical significance( P < 0. 01). The incidence of adverse reactions in group A( 7. 50%) was lower than that in group B( 22. 50%),the difference was statistically significant( χ~2= 4. 117,P = 0. 024). The cost effect of group A was better than group B. Conclusion Lamivudine combined with adefovir dipivoxil is effective,safe and low cost in the treatment of CHB.