51例乙型病毒性肝炎后肝硬化LAM联合ADV三个月后序贯ADV抗病毒疗效观察  

Clinical Antivirus Observation of 51 cases of Posthepatitis B Liver Cirrhosis Treated with Lamivudine Combined with Adefuvir Dipivoxil 3 months and Sequential Treatment with Adefuvir Dipivoxil

作　　者：辛建文[1] 苏静[1] 张鸿[1] 武艳飞[1] 刘瑞峰[1] 

机构地区：[1]内蒙古巴彦淖尔市医院,内蒙古临河015000

出　　处：《内蒙古医学杂志》2008年第12期1475-1478,共4页Inner Mongolia Medical Journal

摘　　要：目的：观察拉米夫定（LAM）联合阿德福韦酯（ADV）3个月后序贯阿德福韦酯治疗乙肝后肝硬化的临床疗效及安全性。方法：将51例乙型病毒性肝炎后肝硬化予以拉米夫定片100mg／d，阿德福韦酯片10mg／d，保肝、利胆等对症、支持和防治各种并发症等治疗，3个月后停用拉米夫定，阿德福韦酯继续治疗1年。观察治疗前及治疗后第1、2、3、6、9、12个月ALT、AST、TBIL、ALB、Child—Pugh评分、血清HBVDNA定量检测，3、6、9、12个月时HBeAg、抗-Hbe的变化。同时对患者监测肾功能及药物不良反应。结果：治疗1个月后，ALT、AST、TBIL较治疗前显著下降（P〈0．01），2个月后ALB显著提高（P〈0．01），3个月后Child—Pugh分级计分显著下降（P〈0．05）。1～3个月内HBVDNA值下降最为明显（P均〈0．01），即便停用拉米夫定以后肝功能、Child—Pugh分级持续改善，HBVDNA阴转率进一步提高，无病毒学反弹和病毒变异发生。部分HBeAg阳性的患者在3个月后开始转换，12个月时达27．6％（8／29）。治疗期间无相关肾功能损害，有6例患者有轻度不良反应，但均能耐受。结论：联合拉米夫定3个月后单用阿德福韦酯治疗乙肝后肝硬化，通过快速抑制HBV的复制，具有控制和逆转肝硬化病情的作用，病毒变异率低，安全性好。Objective：To observe the clinical efficacy and safety of 51 cases of post hepatitis B liver cirrhosis treated with Lamivudine combined with Adefuvir dipivoxil in 3 months, then sequential treatment with Adefuvir dipivoxil. Methods： 51 cases post hepatitis B liver cirrhosis were treated by Lamivudine tablets 100 mg/d, Adefuvir dipivoxil tablets 10 mg/d, hepatic protective and eholeretie effect, prevention various complication, Stopping use Larnivudine and continued treated by the Adefuvir dipivoxil for a year. Observe the index of before and after treatment 1, 2, 3, 6, 9, 12 months ALT, AST, TBIL, ALB, Child - Pugh score, serum HBVDNA quantitative detection. 3, 6, 9, 12 months HbeAg,anti - Hbe were changecl. At the same time, monitoring renal function and adverse drug reactions of patients. Results： After One month treatment, ALT, AST, TBIL decreased significantly than before（P 〈 0.01 ）, 2 months later ALB significantly increased （P 〈 0.01 ）, 3 months later Child - Pugh classification points dropped significantly（P 〈 0.05）. 1- 3months HBVDNA most significant decline in the value （P〈 0.01）. Even after stopping Lamivudine and the liver function and Child- Pugh classification continues to improve. HBVDNA conversion rates further improved, and no rebound in virology and virus mutation occurred. Some HbeAg- positive patients conversed after three months, up to（8/29, 27.6 % ）12 months. No treatment - related renal dysfunction, six patients with mild adverse reactions, but can be tolerated. Conclusion： Combined withLamivudine in three months alone Adefuvir dipivoxil treatment of post hepatitis Bliver cirrhosis, through the rapid HBV suppression, control and reverse cirrhosis of the role of illness, virus mutation rate is low, security is good.

关 键 词：拉米夫定 阿德福韦酯 肝硬化 乙型肝炎病毒 联合治疗 

分 类 号：R575.2[医药卫生—消化系统]