乙型肝炎肝硬化失代偿期抗病毒治疗疗效观察  

Effect of antiretroviral therapy to hepatitis Bcirrhosis

作　　者：冯静[1] 都烽[1] 苏杰[1] 李萍[1] 伦秀英[1] 

机构地区：[1]山东省潍坊市人民医院传染科,261041

出　　处：《中国实用医药》2008年第33期13-14,共2页China Practical Medicine

摘　　要：目的观察核苷类药物治疗乙型肝炎肝硬化失代偿期的疗效。方法对96例乙型肝炎肝硬化失代偿期患者随机分组,所有患者在保肝对症治疗的基础上,分别给予拉米夫定(A组)100mg/d、阿德福韦酯(B组)10mg/d、恩替卡韦(C组)0.5mg/d口服,疗程为48周,同时设立保守治疗组(D组),观察所有患者临床症状、体征、肝功能变化、凝血酶原时间活动度(PTA)、HBV-DNA定量、HBeAg阴转、HBeAg/HBeAb转换情况。结果通过抗病毒治疗,A、B、C三组患者无一例死亡,临床表现、体征、肝功能、PTA均有明显改善,HBeAg血清转换率三组分别为20%、8%、23%,三者统计学处理有显著差异(P<0.05),HBV-DNA阴转率三组分别为48%、28%、68.2%,组间比较有显著差异(P<0.05)。D组疗效最差,死亡3例,抗病毒治疗组与保守治疗组疗效有显著差异(P<0.01)。结论乙型肝炎肝硬化失代偿期患者应行抗病毒治疗,可首先选用拉米夫定或恩替卡韦,为防止应用拉米夫定病毒变异,可在病情好转后改用阿德福韦酯继续治疗。Objective To investigate the clinical therapeutic effect of Nucleoside drugs on decompensated cirrhosis patients following chronic hepatitis B. Methods 96 decompensated cirrhosis patients were randomly divided into four groups, all the groups were given conventional treatment while the group A were given larnivudine 100 rag/day, group B were given adefovir 10 mg/day, group C were given entecavir 0. 5 mg/day, with treatment for 48 weeks. The control group were given conservative treatment only. Then to observe the clinical symptoms, body signs of all the patients, the changes of the liver functions, Prothrombin time activity （PTA）, HBV DNA level and HBeAg negative, HBeAg/HBeAb conversion situation. Results After Nucleoside antiviral treatments for 48 weeks, no patients died in the study groups. Decompensated cirrhosis patients were significantly improved in clinical symptoms , body signs, liver functions, PTA , with decreased I-IBV DNA level（P 〈0. 05） ; the rates of HBeAg negative in these three groups were 20% , 8% and 23% ,there was signif- icant differences for these three groups（ PA/B 〈 0. 05, PC/B 〈 0. 05, PA/C 〈 0. 05 ）, the rates of HBV-DNA negative for these three groups ware 48%, 28% and 68.2%, differences of the three groups were also significant（ PA/B 〈 0. 05, PC/B 〈 0. 05, PA/C 〈 0. 05 ）, the therapeutic efficacy was worst for the control group, 3 cases died, there was an obvious therapeutic efficacy difference between anti-virus treatment groups and control group（P 〈0. 01 ） o Conclusion Decompensated liver cirrhosis patients of Hepatitis B should receive antiretroviral treatment. Latmivudine and Entecavir can be chosen first for the treatment. In order to prevent the viral mutation induced by Lamivudine, use adefovir to continue the antivirus treatment when patients conditions improved.

关 键 词：肝硬化 失代偿 抗病毒治疗 

分 类 号：R512.6[医药卫生—内科学] R575.2[医药卫生—临床医学]