De novo combined lamivudine and adefovir dipivoxil therapy vs entecavir monotherapy for hepatitis B virus-related decompensated cirrhosis

AIM:To compare efficacy of combined lamivudine(LAM)and adefovir dipivoxil(ADV)therapy with that of entecavir(ETV)monotherapy for hepatitis B virus(HBV)-related decompensated liver cirrhosis.METHODS:A total of 120 na ve patients with HBVrelated decompensated cirrhosis participated in this study.Sixty patients were treated with combined LAM and ADV therapy(LAM+ADV group),while the other60 were treated with ETV monotherapy(ETV group)for two years.Tests for liver and kidney function,alpha-fetoprotein,HBV serum markers,HBV DNA load,prothrombin time(PT),and ultrasonography or computed tomography scan of the liver were performed every1 to 3 mo.Repeated measure ANOVA and theχ2test were performed to compare the efficacy,side effects,and the cumulative survival rates at 48 and 96 wk.RESULTS:Forty-five patients in each group were observed for 96 wk.No significant differences in HBV DNA negative rates and alanine aminotransferase(ALT)normalization rates at weeks 48(χ2=2.12 and 2.88)and96(χ2=3.21 and 3.24)between the two groups were observed.Hepatitis B e antigen seroconversion rate in the LAM+ADV group at week 96 was significantly higher in the ETV group(43.5%vs 36.4%,χ2=4.09,P<0.05).Viral breakthrough occurred in 2 cases(4.4%)by week 48 and in 3 cases(6.7%)by week 96 in the LAM+ADV group,and no viral mutation was detected.In the ETV group,viral breakthrough occurred in 1 case(2.2%)at the end of week 96.An increase in albumin(F=18.9 and 17.3),decrease in total bilirubin and in ALT(F=16.5,17.1 and 23.7,24.8),reduced PT(F=22.7 and 24.5),and improved Child-Turcotte-Pugh and the model for end-stage liver disease scores(F=18.5,17.8,and 24.2,23.8)were observed in both groups.The cumulative rates of mortality and liver transplantation were 16.7%(10/60)and 18.3%(11/60)in the LAM+ADV and ETV groups,respectively.CONCLUSION:Both LAM+ADV combination therapy and ETV monotherapy can effectively inhibit HBV replication,improve liver function,and decrease mortality.

Observation on the effect of adefovir dipivoxil in combined with lamivudine in the treatment of hepatitis B cirrhosis

Objective:To explore the effect of adefovir dipivoxil in combined with lamivudine on the liver function in patients with hepatitis B cirrhosis and the antiviral efficacy.Methods:A total of 156 patients with hepatitis B cirrhosis who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 78 cases in each group. The patients in the treatment group were given adefovir dipivoxil in combined with lamivudine, while the patients in the control group were given entecavir. After 12-month treatment, the efficacy was evaluated. The liver function, serum virology indicators, and AFP before and after treatment in the two groups were compared. The adverse reactions during the treatment process were recorded.Results: The serum GTP, ALT, AST, and TBIL levels after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05);moreover, ALT and TBIL levels in the treatment group were significantly lower than those in the control group (P<0.05). HBeAg, HBV-DNA, and AFP levels after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05), HBeAg and AFP levels in the treatment group were significantly lower than those in the control group (P<0.05), and the comparison of HBV-DNA between the two groups was not statistically significant (P>0.05). ALT normalization rate and HBeAg negative conversion rate after treatment in the treatment group were significantly higher than those in the control group (P<0.05). The comparison of HBV-DNA negative conversion rate and HBeAg conversion rate between the two groups was not statistically significant (P>0.05). No obvious drug adverse reactions and liver function damage occurred during the treatment process in the two groups. Conclusions:Adefovir dipivoxil in combined with lamivudine can significantly improve the liver function and serum virology indicators in patients with hepatitis B cirrhosis, with antiviral efficacy significantly superior to that by entecavir.

Lamivudine treatment of decompensated hepatitis B virus-related cirrhosis

BACKGROUND: Patients with decompensated hepatitis B vires (HBV)-related cirrhosis tend to have low or undetectable HBV replication. However, some patients continue to have high levels of HBV replication and effective suppression of HBV replication with antiviral agents may potentially decrease hepatic necroinflammation and improve or stabilize liver function. This review was to under stand the efficacy and safety of lamivudine in the treatment of decompensated HBV cirrhosis. DATA SOURCES: An English-language literature search (MEDLINE January 1988-July 2005) was performed, and a total of 52 articles/abstracts relevant to the issue were selected. After review of the selected papers, the meaningful results and conclusions were extracted using scientific crite ria. The papers reviewed pertained mainly to the efficacy and safety profiles of lamivudine treatment for decompensated HBV cirrhosis. RESULTS: The ultimate treatment of decompensated HBV cirrhosis is liver transplantation, but lamivudine treatment may lead to rapid suppression of viral replication and improvement of biochemical and clinical parameters, reduced morbidity and hospitalization for complications of liver disease, increased pre-transplant survival as well as reduced need for transplantation. However, viral resistance can develop after prolonged treatment with lamivudine, and breakthrough hepatitis may be fatal in few patients. Adefovir is effective for lamivudine-resistant HBV mutants. CONCLUSIONS: Antiviral therapy with lamivudine for decompensated HBV cirrhosis can be effective. However, some patients may experience a hepatitis flare with the emergence of YMDD mutants resulting in progressive worsening of liver disease, and should be referred for 'rescue' therapy with other nucleoside/nucleotide analogues such as adefovir dipivoxil.

De novo combination therapy with lamivudine and adefovir dipivoxil in chronic hepatitis B patients

AIM:To investigate the appropriate time for combination therapy in HBeAg positive chronic hepatitis B(CHB) patients with decompensated cirrhosis.METHODS:Thirty HBeAg positive CHB patients with decompensated cirrhosis were enrolled in the study.All of the patients were given 48 wk combination therapy with lamivudine(LAM) and adefovir dipivoxil(ADV) .Briefly,10 patients were given the de novo combination therapy with LAM and ADV,whereas the other 20 patients received ADV in addition to LAM after hepatitis B virus(HBV) genetic mutation.RESULTS:Serum alanine aminotransferase and total bilirubin were both improved in the two groups at 4,12,24 and 48 wk after treatment.Serum albumin was also improved at 24 and 48 wk after combination therapy in both groups.The serum HBV DNA level wasstill detectable in every patient in the two groups at 4 and 12 wk after combination treatment.However,in the de novo combination group,serum HBV DNA levels in 4(40%) and 9(90%) patients was decreased to below 1×10 3 copies/mL at 24 and 48 wk after the combination treatment,respectively.In parallel,serum HBV DNA levels in 2(20%) and 8(40%) patients in the add-on combination group became undetectable at 24 and 48 wk after combination treatment,respectively.Furthermore,6(60%) patients in the de novo combination group achieved HBeAg seroconversion after 48 wk treatment,whereas only 4(20%) patients in the add-on combination group achieved seroconversion.Child-Pugh score of patients in the de novo combination group was better than that of patients in the add-on combination group after 48 wk treatment.Moreover,patients in the de novo combination group had a significantly decreased serum creatinine level and elevated red blood cell counts.CONCLUSION:De novo combination therapy with LAM and ADV was better than add-on combination therapy in terms of Child-Pugh score,virus inhibition and renal function.

Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants

BACKGROUND: The recurrence of chronic hepatitis B after liver transplantation results in increased risk for graft failure and death of patients. Lamivudine has been shown to be effective in the treatment of chronic hepatitis B, but resistance to this agent is common after prolonged administration. METHODS: One patient with chronic hepatitis B virus (HBV) infection developed resistance to lamivudine after 15 months of treatment. The resistance was confirmed by mutation in the HBV DNA polymerase gene. The patient was treated subsequently with adefovir dipivoxil for 7 months. RESULT: HBV DNA and HBsAg were tested negative, but HBeAb and HBsAb were positive. CONCLUSION: This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants.

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

We report the case of a patient treated with living donor-related liver transplantation who suffered from osteomalacia during adefovir dipivoxil (ADV)-containing antiviral therapy for lamivudine-resistant hepatitis B virus infection. The patient had generalized bone pain,with severe hypophosphatemia after 20 mo of ADV therapy. Radiographic studies demonstrated the presence of osteomalacia. The peak plasma ADV level was 38 ng/mL after administration of ADV at 10mg/day. It was also found that ADV affected the metabolism of tacrolimus,a calcineurin-inhibitor,and caused an increase in the plasma levels of tacrolimus. The disability was reversed with the withdrawal of ADV and with mineral supplementation. ADV can cause an elevation of plasma tacrolimus levels,which may be associated with renal dysfunction. High levels of ADV and tacrolimus can cause nephrotoxicity and osteomalacia. This case highlights the importance of considering a diagnosis of osteomalacia in liver transplantation recipients treated with both ADV and tacrolimus.

Response-guided treatment of cirrhotic chronic hepatitis B patients: Multicenter prospective study

AIM: To observe the effect of response-guided add-on therapy with adefovir(ADV) and lamivudine(LAM) in cirrhotic hepatitis B(CHB) patients.METHODS: A total of 100 patients with CHB and cirrhosis were divided into three arms according to hepatitis B virus(HBV) DNA level after 24 wk LAM monotherapy: Arm A(complete response, HBV DNA ≤ 60 IU/m L, n = 49), Arm B(partial response, HBV DNA: 60-2000 IU/m L, n = 31) and Arm C(inadequate response, HBV DNA > 2000 IU/m L, n = 20). ADV was added to LAM at week 48 in Arms A and B, but at week 24 in Arm C. Virological response, YMDD mutations, biochemical response, and liver function were evaluated.RESULTS: Comparison of the three arms demonstrated that early complete virologic response at week 24was associated with maintained viral suppression(undetectable rate of HBV DNA at week 144 was 95.96%, 66.67% and 35.29%, respectively, P = 0.000) and reduced YMDD mutations(mutation rate at week 144 was 0%, 3.23% and 15%, respectively, P = 0.015) after 144 wk treatment. For patients who failed to achieve complete virological response at week 24, switching to combination therapy further decreased HBV DNA level by 1 log10 IU/m L. All three arms obtained biochemical benefits including decline of alanine aminotransferase and elevation of albumin. In patients who developed HBV DNA breakthrough for YMDD mutations, ADV add-on therapy did not induce further multiple drug resistance to LAM or ADV.CONCLUSION: Optimized response-guided add-on therapy of ADV and LAM maintains long-term suppression of HBV DNA and improves liver function in CHB patients with compensated liver cirrhosis.

Efficacy observation of Yiguanjian decoction combined adefovir Dipivoxil tablet in treating HBeAg negative chronic viral hepatitis B active compensated liver cirrhosis patients

Objective To explore clinical efficacy of Yiguanjian Decoction(YD)combined Adefovir Dipivoxil Tablet(ADT)in treating HBe Ag negative chronic viral hepatitis B(CVHB)active compensated liver cirrhosis(LC)patients.Methods Totally 68 HBe Ag negative CVHB active compensated LC patients initially treated were assigned to the treatment group and the control group

低剂量乙肝免疫球蛋白与拉米夫定长期联用预防肝移植后HBV复发

目的:评价长期低剂量HBIgim联用LAM预防急慢性HBV相关性终末期肝病OLT后HBV复发的效能.方法:肝移植患者173例,根据OLT后接受的抗病毒预案分成3组,LAM组(n=2)、HBIg+LAM组(n=168)和阿德福韦组(ADF,n=3).所有OLT受者术前至少接受1-2wkLAM治疗.施药剂量,LAM100mg/d,阿德福韦10mg/d.术中和术后1wk内,HBIg每日静脉给予(HBVDNA>108copies/L,总量10000U;否则总量5000U);此后imHBIg400U/次,并根据血中HBsAb滴度调整im间隔时间.1mo内维持HBsAb滴度>300U/L;3mo内HBsAb滴度>200U/L;超过3moHBsAb滴度>100U/L.定期检测肝功能、血清HBV标志物,必要时穿刺肝组织免疫组化检查.平均随访20.8±14mo.统计3种预案HBV复发的例数并分析原因;与国外同期研究结果比较.结果:4例HBV复发.LAM组1例HBV复发,术后1wkHBsAg(+),术后2moHBV(+),伴ALT升高,诊断LAM药物耐受;术后8mo死于多器官功能衰竭.HBIg+LAM组3例HBV复发,分别出现在12d,12mo和1.5mo;3例患者术前HBV-DNA>108copies/L.第1例术后血中HBeAg和HBVDNA持续(+),血中HBsAb滴度远低于有效预防浓度,诊断HBIg治疗失败,术后11mo死于爆发性肝炎.第2例成为乙肝携带者,术后15mo死于肿瘤复发.第3例HBV复发后改用HBIg+阿德福韦治疗,术后5.5moHBsAg(-),目前肝功能正常.第2和第3例可能存在HBV逃逸突变.阿德福韦组受者随访期间无HBV复发.HBIg+LAM预案,HBV相关性终末期肝病OLT后HBV复发率为1.8%(3/168);所有患者imHBIg耐受性好.OLT后HBV复发率与国外肝移植部比较,两者无统计学意义(χ2=0.28037),预防费用3000-4000＄/a.结论:长期低剂量HBIgim联用LAM可以有效预防HBV相关性终末期肝病OLT后的HBV复发,费用相对低.阿德福韦治疗HBV-YMDD变异株有效,可能是预防HBV复发的更有效因子.

白花香莲解毒方联合阿德福韦酯对HBeAg阳性慢性乙型肝炎患者病毒学及生存质量的影响

目的:通过观察壮药白花香莲解毒方联合阿德福韦酯对HBeAg阳性的慢性乙型肝炎(CHB)患者病毒学及生存质量的影响,评估其临床疗效。方法:采用多中心随机临床研究方法,将240例HBeAg阳性的CHB患者随机分为治疗组和对照组,对照组给予阿德福韦酯胶囊10mg/次,1次/d,治疗组在对照组基础上加用白花香莲解毒方,两次/d,疗程为48周。分别观察治疗12周、24周、48周两组患者在病毒学、生存质量(QOL)、慢性肝病量表(CLDQ)评分情况。结果:①病毒学方面:从治疗12周始,治疗组HBV DNA下降的对数值与对照组比较,差异有显著性意义(P<0.05);治疗组治疗12周、24周病毒学应答率分别为65.48%(74例)、82.3%(92例),对照组为51.78%(58例)、70.53%(79例),差异有显著性意义(P<0.05);治疗48周,两组患者总的病毒学应答率比较差异无显著性意义(P>0.05);治疗组治疗12周、24周、48周的HBV DNA阴转率分别为22.12%(25例)、43.36%(49例)、57.52%(65例),对照组为11.61%(13例)、21.4%(24例)、32.14%(36例),差异有显著性意义(P<0.05)。②QOL方面:治疗24周,治疗组在生理领域、心理领域改善作用优于对照组;治疗48周治疗组在总的生存质量、总的健康状况、生理领域、心理领域、社会关系领域均优于对照组,两组比较差异有显著性意义(P<0.05)。③CLDQ评分方面:治疗24周,治疗组患者在乏力、情感功能、焦虑三方面改善程度优于对照组;治疗48周治疗组患者在乏力、全身症状、情感功能、焦虑四方面改善程度优于对照组,两组比较差异有显著性意义(P<0.05)。④不良事件:两组患者主要不良反应为头痛、腹痛、恶心;研究期间共发生磷酸肌酸激酶(CK)升高9例,发生率为4%。结论:白花香莲解毒方联合阿德福韦酯治疗HBeAg阳性CHB患者,能显著提高其对HBV DNA的抑制作用,改善患者生存质量。

脂肪肝对HBeAg阳性慢性乙型肝炎患者疗效的影响

目的 探讨脂肪肝对HBe Ag阳性慢性乙型肝炎（CHB）患者应用阿德福韦酯抗病毒疗效的影响及其对于HBs Ag预测抗病毒疗效价值的影响。方法 选择2012年1月~2014年12月在该院门诊就诊的71例e抗原阳性CHB患者为研究对象,其中40例为单纯乙肝组,乙肝合并非酒精性脂肪肝（NAFID）31例为乙肝合并脂肪肝组。两组患者均给予阿德福韦酯10 mg/d口服抗病毒治疗24周及36周,观察两组HBV-DNA阴转率（完全病毒学应答）有无差异。根据是否获得病毒学应答将单纯乙肝组及乙肝合并脂肪肝组分别分为完全病毒学应答组及无应答组,分别观察两组中的两亚组患者HBV-DNA、HBs Ag在治疗过程中的变化趋势。结果 乙肝合并脂肪肝组在治疗24、36周HBV-DNA阴转率分别为48.4%和61.3%,显著低于单纯乙肝组的75.0%、82.5%,差异有统计学意义（P〈0.05）。在单纯乙肝组中,两亚组患者HBs Ag含量在治疗后24周和治疗后36周时均随着HBV-DNA水平逐渐下降,完全病毒学应答组血清HBV-DNA及HBs Ag水平明显低于无应答组,差异有统计学意义（P〈0.01）。在乙肝合并脂肪肝组中,两亚组患者在治疗后24周和36周时HBV-DNA均明显下降,差异有统计学意义（P〈0.01）;完全病毒学应答组HBs Ag含量在治疗过程中虽有下降趋势,但无论在治疗后24周还是36周时与无应答组比较,差异无统计学意义（P〉0.05）。结论 合并脂肪肝影响乙型肝炎患者的HBV-DNA阴转率;乙肝合并脂肪肝时,HBs Ag定量值变化不能反映治疗后病毒学应答情况。

拉米夫定联合阿德福韦酯对乙型肝炎肝硬化患者血清血小板衍性生长因子BB和其他肝纤维化指标的影响

目的探讨拉米夫定联合阿德福韦酯对乙型肝炎肝硬化患者血清血小板衍性生长因子BB和其他肝纤维化指标的影响。方法选择72例慢性乙型肝炎早期肝硬化患者,随机分为两组,每组各36例,对照组给予正常的护肝、降酶等综合性治疗的方法,治疗组拉米夫定和阿德福韦酯进行联合治疗。两组治疗3个月后,检测肝纤维化指标水平、血小板衍性生长因子BB、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)以及肝功各项指标水平。结果治疗组发生改变,肝功的各项指标也都发生改变,都较对照组有着明显的改善效果,差异有统计学意义(P<0.05)。治疗后两组比较,治疗组患者凝血功能[PT:(13.25±2.61)s;APTT:(31.27±3.59)s;FIB:(317.58±57.46)U/L]改善更明显优于对照组[PT:(16.83±4.32)s;APTT:(45.64±4.86)s;FIB:(163.15±48.64)U/L](P<0.05)。结论拉米夫定联合阿德福韦酯治疗对改善乙型肝炎肝硬化患者血清肝纤维化指标和凝血指标方面有较好的效果。

阿德福韦酯在治疗69例HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水中的临床作用观察

目的了解阿德福韦酯(ADV)在治疗HBe Ag阳性失代偿期乙型肝炎所致肝硬化腹水中的临床作用,为该疾病提供有效的内科治疗手段。方法 135例HBe Ag阳性失代偿期乙型肝炎所致肝硬化腹水患者被随机分为治疗组69例和对照组66例。两组均给予相同的常规内科治疗,治疗组加用ADV治疗。治疗期间观察所有病例的临床症状与体征;治疗前和治疗6个月后分别检测天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、HBV血清标志物和HBV-DNA等;并观察药物不良反应。结果治疗组的腹胀、乏力、腹水消失时间均小于对照组,差异均有统计学意义(t=4.589、6.845、5.880,均P<0.05)。治疗6个月后,治疗组的HBV DNA转阴率高于对照组,差异有统计学意义(χ2=3.215,P<0.05)。治疗组的AST、ALT、TBIL、Child-Pugh评分均低于对照组,差异均有统计学意义(t=3.774、5.623、5.120、3.159,均P<0.05)。治疗组的显效率为27.5%,总有效率为65.2%,均高于对照组,差异均有统计学意义(χ2=11.256、4.070,均P<0.05)。治疗期间ADV的不良反应发生率为7.2%(5/69)。结论 ADV用于治疗HBe Ag阳性失代偿期乙型肝炎所致肝硬化腹水,疗效显著,不良反应发生率低,具有较好的临床应用价值。

重组人干扰素α-2b联合阿德福韦酯治疗乙肝肝硬化的效果及其对AQP8和AQP9蛋白水平的影响

目的研究重组人干扰素α-2b联合阿德福韦酯治疗乙肝肝硬化的效果及其对AQP8和AQP9蛋白水平的影响。方法选取我院2018年1月至2020年1月收治的122例乙肝肝硬化患者为研究对象,采用随机数字法将其分为对照组和观察组,每组61例。对照组给予阿德福韦酯治疗,观察组在此基础上联合重组人干扰素α-2b治疗。比较两组患者的治疗效果。结果治疗后,观察组的TBIL、AST、ALT水平均明显低于对照组(P<0.05);观察组的HBV-DNA转阴率明显高于对照组(P<0.05);治疗后,观察组AQP8、AQP9水平明显高于对照组(P<0.05)。结论重组人干扰素α-2b联合阿德福韦酯治疗乙肝肝硬化的临床效果显著,可提高AQP8和AQP9蛋白的表达水平,抑制HBV的复制,促进肝脏功能恢复,且安全性较高,值得在临床推广。

阿德福韦酯对慢性乙肝患者血清Th1/Th2类细胞因子、肝功能及HBV DNA复制的影响

目的研究阿德福韦酯对慢性乙肝患者血清Th1/Th2类细胞因子、肝功能及HBV DNA复制的影响机制。方法100例慢性乙肝患者随机分为观察组(阿德福韦酯+常规治疗)和对照组(常规治疗)各50例,比较两组的疗效及治疗前后IFN-γ、IL-4、IFN-γ/IL-4及肝功能、HBV DNA复制、应答情况。结果观察组的疗效明显高于对照组,观察组和对照组IFN-γ、IFN-γ/IL-4治疗后均较治疗前明显升高,IL-4较治疗前明显降低,ALT、TBil治疗后均较治疗前明显降低,ALB较治疗前明显升高,且观察组较对照组变化更显著(P<0.05)。治疗12周、16周、24周、36周、48周时,观察组HBV DNA≤105拷贝/mL、HBV DNA<104拷贝/mL均明显多于对照组。治疗16周以后,观察组HBV DNA<103拷贝/mL多于对照组。治疗12周、16周时,观察组和对照组均无完全应答,但观察组部分应答比例明显高于对照组。治疗24周、36周、48周时,观察组完全应答和部分应答比例均明显高于对照组。结论阿德福韦酯治疗慢性乙肝疗效确切,能明显抑制HBV复制,促进ALT复常,且还能通过免疫调节作用抑制病毒复制,值得临床推广和应用。

恩替卡韦与阿德福韦酯对HBeAg阳性乙肝肝硬化失代偿期患者肝功能的影响

目的对比恩替卡韦与阿德福韦酯对HBeAg阳性乙肝肝硬化患者肝功能的影响。方法方便选取2015年1月—2016年6月该院收治的HBeAg阳性失代偿期乙肝肝硬化患者85例作为研究对象,根据治疗方案的差异将其分为恩替卡韦组与阿德福韦酯组,两组患者治疗前人口学特征、肝功能状况、病毒学资料比较差异无统计学意义,其中阿德福韦酯组40例患者应用阿德福韦酯治疗,恩替卡韦组45例患者应用恩替卡韦治疗,比较两组患者治疗效果及治疗后肝功能变化情况。结果两组患者治疗后ALT复常率及HBeAg转阴率比较(10.00%vs13.33%,72.50%vs71.11%),差异无统计学意义(P>0.05),治疗后恩替卡韦组TBIL、Child-Pugh评分、HBV DNA阴转率明显优于阿德福韦酯组,差异有统计学意义(P<0.05),两组患者治疗期间未见明显药物不良反应及肾功能变化。结论恩替卡韦与阿德福韦酯治疗乙型病毒性肝炎失代偿性肝硬化均具有良好的疗效,但恩替卡韦对患者肝功能的改善效果更为显著,临床可结合患者实际病情选择恰当的药物治疗方案以提升临床治疗效果。

拉米夫定联合阿德福韦酯治疗HBeAg阳性失代偿期乙型肝炎肝硬化患者的临床疗效

目的:探究拉米夫定联合阿德福韦酯治疗HBe Ag阳性失代偿期乙型肝炎(乙肝)肝硬化患者的临床疗效。方法:选取80例HBe Ag阳性失代偿期乙肝肝硬化患者作为研究对象,进行分组研究。观察组40例患者给予拉米夫定加阿德福韦酯初始联合治疗,对照组40例患者给予拉米夫定初始治疗耐药后,加用阿德福韦酯继续挽救治疗。比较两组患者的临床疗效。结果:两组患者Child-Pugh分级评分情况,在第12周时,两组患者的分级评分情况没有显著的差异,但是在两组患者治疗24周、48周时,观察组患者的Child-Pugh分级评分,明显低于对照组,组间对比P<0.05,差异有统计学意义。结论:采用拉米夫定初始联合阿德福韦酯治疗HBe Ag阳性失代偿期乙肝肝硬化患者,能够良好地降低患者的耐药性,改善患者的肝功能,提高治疗效果,值得推广。

阿德福韦酯联合苦参素胶囊对CHB肝硬化治疗效果及患者HBV-DNA的影响

目的研究和观察阿德福韦酯联合苦参素胶囊治疗慢性乙型肝炎(CHB)肝硬化患者的疗效及对患者DNA载量(HBVDNA)的影响。方法随机选取180例CHB肝硬化患者作为研究对象,依据治疗方式的不同分为单一用药的对照组(90例)和联合用药组(90例),其中对照组给予阿德福韦酯治疗,联合用药组给予阿德福联合苦参素胶囊治疗。所有患者均以48周为1个疗程,比较两组患者的疾病转归及对HBV-DNA的影响。结果治疗后ALT、TBIL复常率及HBeAg转阴率,两组比较差异具有统计学意义(P<0.05),但HBeAg/HBeAb血清转换组间比较差异不明显(P>0.05)。随着治疗的进行,两组患者的HBVDNA含量呈下降趋势,HBV-DNA转阴率呈上升趋势,第12、24周,联合用药组在HBV-DNA含量及转阴率上显著优于对照组,差异具有统计学意义(P<0.05),第36、48周组间比较HBV-DNA含量及转阴率差异无统计学意义(P>0.05)。经治疗,两组患者肝纤维化各指标较治疗前均有改善(P<0.05)。联合用药组在LN、PC-Ⅲ及Ⅳ-C指标上改善程度与对照组相比,差异具有统计学意义(P<0.05),但HA指标比较无明显差异(P>0.05)。结论阿德福韦酯联合苦参素胶囊能够抑制乙肝病毒复制,降低HBV-DNA含量,防止肝细胞损伤及肝纤维产生,疗效显著,值得临床推广运用。

拉米夫定联合阿德福韦酯治疗HBeAg阳性失代偿期乙肝肝硬化的临床效果

目的:探讨拉米夫定联合阿德福韦酯治疗HBeAg阳性失代偿期乙肝肝硬化的临床效果。方法:收治乙肝肝硬化的HBeAg阳性失代偿期患者50例,分为两组。对照组先使用拉米夫定,后使用阿德福韦酯,研究组在初始治疗时即联合使用拉米夫定及阿德福韦酯,比较两组临床疗效。结果:研究组HBeAg血清转阴率、Child-Push评分、HBV-DNA载量均优于对照组(P<0.05)。结论:初始治疗时拉米夫定联合阿德福韦酯治疗HBeAg阳性失代偿期乙肝肝硬化患者的临床效果显著。

阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者疗效观察

目的：探讨阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者临床疗效。方法选择我院2011～2012年感染科收治的40例干扰素无应答HBeAg阳性慢性乙型肝炎患者的资料，根据患者治疗方式，将患者分为观察组及对照组各20例，两组均应用阿德福韦酯治疗，观察组患者加用苦参素片口服，连续治疗12个月，治疗前后测定患者肝功能生化指标及病毒指标。结果观察组患者肝功能生化指标及病毒指标改善明显，优于对照组，比较差异有统计学意义（P＜0.05）。结论阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者，能有效抑制体内HBV复制，有较好的改善肝功能和抗纤维化的作用，效果满意。