拉米夫定治疗乙型肝炎失代偿期肝硬化长期疗效观察  

Long-term lamivudine treatment for decompensated cirrhosis due to hepatitis B

作　　者：杜以真[1] 王磊[2] 刘峰[1] 秦来英[1] 范桂玲[1] 张照华[1] 王耀宗[1] 

机构地区：[1]济南市传染病医院,250021 [2]山东大学医学院传染病学教研室

出　　处：《肝脏》2006年第5期318-321,共4页Chinese Hepatology

摘　　要：目的观察慢性乙型肝炎病毒（HBV）感染所致失代偿期肝硬化患者应用拉米夫定抗病毒治疗的疗效和安全性。方法60例伴有HBV复制的失代偿期肝硬化患者（Child—Pugh B级20例，C级40例）接受拉米夫定抗病毒治疗，剂量为100mg或150mg，每日1次，早期同时给予支持及对症治疗。在治疗1、2、3、4、5和6年时分别进行疗效评价。结果所有患者治疗3-6个月后症状和体征逐渐改善，腹水消失。未发生YMDD变异者，血清转氨酶、黄疸、白蛋白和Child—Pugh计分的改善贯穿于整个治疗过程。治疗1、2、3、4、5和6年时，丙氨酸氨基转移酶复常率分别为87．8％、87．0％、85．9％、84．3％、79．8％和76．5％；天冬氨酸氨基转移酶复常率分别为78．2％、79．3％、75．7％、73．2％、74．2％和72．1％；总胆红素复常率分别为65．6％、85．2％、78．1％、72．3％、78．6％和76．5％；白蛋白复常率分别为86．9％、85．2％、92．9％、85．6％、86．4％和71．2％；治疗前Child—Pugh计分为12．61±2．05，服药1-6年后分别降至10．7±3．1、8．7±1．6、7．5±1．2、7．2±1．2、6．9±0．8和6．9±0．6；血清HBVDNA阴转率分别为91．4％（53／58）、82．7％（43／52）、83．7％（41／49）、76．7％（33／43）、65．7％（23／35）和73．7％（14／19）；血清HBeAg／抗HBe转换率分别为32．6％（15／46）、43．1％（19／42）、46．3％（19／41）、52．3％（19／35）、48．4％（15／31）和40％（6／15）。累计23例发生YMDD变异。累计存活率59．6％（34／57）。结论拉米夫定治疗HBV所致失代偿期肝硬化，可迅速控制病毒复制，改善肝功能，降低Child—Pugh计分，促使HBeAg／抗HBe血清转换。长期用药安全，耐受性好。Objective The aim of this study was to evaluate the efficacy and safety of lamivudine treatment for decompensated cirrhosis due to chronic hepatitis B. Methods 60 patients with decompensated cirrhosis of hepatitis B virus （HBV） infection （20 Child- Pugh class B and 40 Child-Pugh class C） were treated with lamivudine （ 100 mg or 150 mg once daily） for 1 to 6 years. Supportive treatment and symptomatic treatment were given if necessary at early stage of lamivudine treatment. Results Symptoms of all patients were relieved gradually after 3 to 6 months. Ascites disappeared in all patients who had had that at beginning of the study. The alanine aminotransferase （ALT） , bilirubin, albumin levels and Child-Pugh score were improved in patients without YMDD mutation. HBV DNA undetectable （defined as 〈 1 000 copies/ml by Roche Amplicor） rates were 91.4% （53/58）, 82.7% （43/52）, 83,7% （41/49）, 76.7% （33143）, 65.7% （23135） and 73.7% （14/19） at yearl, 2, 3, 4, 5 and 6 years, respectively. The ALT normalized rates were 87.8%, 87.0%, 85.9%, 84.3%, 79.8% and 76.5% at year 1, 2, 3, 4, 5 and 6 years, respectively. And the aspartate aminotransferase （AST） normalized rates were 78.2% , 79.3 % , 75.7% , 73,2%, 74.2% and 72.1%, respectively. The total bilirubin normalized rates were 65.6% ,85.2%, 78.1%, 72.3 %, 78.6% and 76.5 %. Serum albumin returned to normal rates were 86.9%, 85.2%, 92.9%, 85.6%, 86.4% and 71.2%, respectively. The Child-Pugh scores decreased from 12.61 ± 2.05 at the pretreatment to 6.9 ± 0.6 at the post-treatment, The virologic response rates were 91.4% （53/58） at year 1 to 73.7% （14/19） at the 6th year. The HBeAg/Anti-HBe seroconversion rates were 32.6% （15/46） at 1 year to 40% （6/15） at the 6th year. 23 of patients developed YMDD mutation during the study. Conclusion Lamivudine can inhibit HBV replication rapidly in decompensated cirrhosis patients due to hepatitis B, resulting in an improvement in liver function, a decrease in Child-Pugh score, a

关 键 词：乙型肝炎病毒 失代偿期肝硬化 拉米夫定 Child—Pugh计分 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]