阿德福韦酯联合拉米夫定治疗对活动性代偿期乙型肝炎肝硬化患者肝功能、抗病毒效果及生存率的影响

Effects of Adefovir Dipivoxil Combined with Lamivudine on Liver Function,Antiviral Efficacy and Survival Rate in Treatment of Patients with Hepatitis B Cirrhosis and Hepatic Cirrhosis at Active Compensatory Stage

目的探讨阿德福韦酯联合拉米夫定治疗对活动性代偿期乙型肝炎肝硬化患者肝功能、抗病毒效果及生存率的影响。方法选取2015年1月—2017年1月本院收治的112例活动性代偿期乙型肝炎肝硬化患者,根据治疗方法不同分为观察组52例和对照组60例,对照组采用拉米夫定片治疗,观察组在对照组基础上联合阿德福韦酯片治疗。比较2组治疗后临床疗效、治疗前后肝功能指标变化和乙型肝炎病毒(HBV)DNA定量及其转阴率,并随访2年,比较2组治疗后6、12、18、24个月的生存率及随访期间肝癌发生率。结果治疗后,观察组总有效率显著高于对照组(P<0.05)。治疗后2组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、HBV DNA定量明显降低,白蛋白(Alb)水平明显升高,且观察组ALT、AST、TBIL、HBV DNA定量显著低于对照组,Alb水平显著高于对照组,差异均有统计学意义(P<0.05或P<0.01)。观察组HBV DNA转阴率显著高于对照组(P<0.05)。治疗后18、24个月观察组生存率均高于对照组(P<0.05)。2组随访期间肝癌发生率比较差异无统计学意义(P>0.05)。结论活动性代偿期乙型肝炎肝硬化患者采用阿德福韦酯联合拉米夫定治疗可取得较好的临床效果,可明显改善患者肝功能、降低HBV DNA水平、提高HBV DNA转阴率,对延长患者生存期有重要意义。

Objective To investigate effects of Adefovir Dipivoxil combined with Lamivudine on liver function,antiviral efficacy and survival rate in treatment of patients with hepatitis B cirrhosis and hepatic cirrhosis at active compensatory stage.Methods A total of 112 patients with hepatitis B cirrhosis and hepatic cirrhosis at active compensatory stage admitted during January 2015 and January 2017 were selected and divided into observation group(n=52)and control group(n=60)according to different treatment methods.Control group was treated with Lamivudine Tablets,while observation group was treated with Adefovir Dipivoxil Tablets on the basis of treatment for control group.Clinical efficacy,changes of liver function indexes before and after treatment,hepatitis B virus(HBV)DNA quantitation and negative conversion rate were compared between two groups.The patients were followed up for 2 years.Survival rates after treatment for 6,12,18 and 24 months and incidence rate of liver cancer during the follow-up period were compared between two groups.Results After treatment,the total effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,values of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and HBV DNA quantitation were significantly decreased,while ALB levels were significantly increased in two groups;in observation group,values of ALT,AST,TBIL and HBV DNA quantitation were significantly lower than those in control group,while albumin(ALB)level was significantly higher than that in control group(P<0.05 or P<0.01).The negative conversion rate of HBV DNA in observation group was significantly higher than that in control group(P<0.05).Survival rates after treatment for 18 and 24 months in observation group were significantly higher than those in control group(P<0.05).There was no significant difference in incidence rate of liver cancer during the follow-up period between two groups(P>0.05).Conclusion Adefovir Dipivoxil combined with Lamivudine in treatment of patients with hepatitis B cirrhosis at active compensatory stage may achieve good clinical efficacy,significantly improve liver function,reduce HBV DNA level and increase negative conversion rate of HBV DNA,which is of great significance to prolong life span of patients.