替比夫定治疗乙型肝炎肝硬化的疗效观察  

Telbivudine treatment on cirrhosis resulting from chronic hepatitis B

作　　者：梁静[1] 韩涛[1] 肖时湘[1] 李岩[1] 阚志超[1] 刘磊[1] 

机构地区：[1]天津市第三中心医院肝内科,300107

出　　处：《中华肝脏病杂志》2009年第1期24-27,共4页Chinese Journal of Hepatology

摘　　要：目的观察替比夫定治疗乙型肝炎肝硬化患者48周时的疗效。方法80例乙型肝炎肝硬化患者分为两组，每组40例，分别给予口服替比夫定600mg／d或拉米夫定100mg／d，持续治疗48周。观察治疗不同时间点患者的病毒学、生物化学指标、凝血酶原活动度（PTA）、Child—Pugh积分及病毒耐药等变化情况。结果替比夫定组患者血清HBVDNA在治疗前为（6．52±1．33）10g10拷贝／ml，在接受替比夫定治疗后2、4、8、12、24、48周时的下降值分别为（2．09士1．30）lOglo拷贝／ml、（2．83±1．22）10g10拷贝／ml、（3．23±1．27）log10拷贝／ml、（3．42±1．32）log10拷贝／ml、（3．65±1．30）log1o拷贝／ml及（3．67±1．43）log10拷贝／ml。在24、48周时均有92．5％（37／40）的患者HBVDNA阴转。在治疗24、48周时，分别有30．0％（6／20）及35．0％（7／20）的患者出现了HBeAg血清学转换。在治疗48周时ALT、AST明显下降，白蛋白、总胆红素、PTA及Child—Pugh积分等指标均有所改善（P〈0．05），治疗48周时替比夫定组YMDD变异率为5．0％。治疗后24、48周HBVDNA水平下降值、HBVDNA阴转率替比夫定组高于拉米夫定组（P〈0．05）。结论替比夫定能快速有效抑制乙型肝炎肝硬化患者的病毒复制，使HBVDNA水平下降，同时可以改善肝功能，且具有较低耐药率。Objective To study the therapeutic efficacy of 48-week telbivudine treatment on cirrhosis resulting from chronic hepatitis B. Methods 80 patients were equally divided into two groups, and treated with telbivudine 600 mg or lamivudine 100mg once daily for 48 weeks, respectively. The changes of virological and biochemical markers, PTA, Child-Pugh score, and viral resistance were observed at the different time points after antiviral treatment. Result The mean of serum HBV DNA level in telbivudine group before treatment was （6.52 ± 1.33） log10 copies/ml, and the mean reduction of serum HBV DNA was （2.09 ±1.30）, （2.83 ±1.22）, （3.23 ± 1.27）, （3.42 ± 1.32）, （3.65± 1.30）, （3.67 ±1.43） log10 copies/ml at 2, 4, 8, 12, 24, 48 weeks, respectively. The proportion of patients with serum HBV DNA undetectable was 92.5% （37/40） at 24, 48 weeks. At week 24 and 48, the rates of HBeAg/anti-HBe seroconversion were 30.0% （6/20）, 35.0% （7/20）, respectively. ALT, AST, albumin, total bilirubin, PTA, and Child-Pugh score were improved （P 〈 0.05）. Mutation of YMDD observed in telbivudine group was 5.0%. The mean reduction of serum HBV-DNA and the proportion of patients with undetectable serum HBV-DNA were greater in telbivudine group than in lamivudine group （P 〈 0.05）. Conclusions Telbivudine can rapidly and effectively inhibit the replication of HBV in patients with cirrhosis resulting from chronic hepatitis B, and the resistance mutation rate was low. In addition, telbivudine treatment can improve the liver function.

关 键 词：肝硬化 肝炎 乙型 慢性 拉米夫定 替比夫定 

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