阿德福韦酯联合拉米夫定治疗代偿期乙型肝炎肝硬化疗效观察  

Clinical Observation of Post Hepatitis B Liver Cirrhosis Treated with Adefuvir Dipivoxil Combined With Lamivudine

作　　者：蒋远明[1] 唐坤伦[1] 谢巍[1] 赵川[1] 

机构地区：[1]遂宁市中心医院,四川遂宁629000

出　　处：《寄生虫病与感染性疾病》2009年第4期195-197,共3页Parasitoses and Infectious Diseases

摘　　要：目的观察阿德福韦酯联合拉米夫定及拉米夫定单用治疗代偿期乙型肝炎肝硬化的疗效和安全性。方法62例患者在保肝、对症支持等综合治疗的基础上分为A、B两组。A组(32例)每日口服阿德福韦酯10mg和拉米夫定100mg联合治疗,B组(30例)每日仅口服拉米夫定100mg,疗程均为48周。观察患者治疗前后临床表现、生化学指标、病毒学及肝纤维化指标改变情况及不良反应。结果62例患者治疗后病情稳定,肝功能恢复正常;A组HBV-DNA<103cp/ml者占62.5%,HBeAg阴转率达37.5%,病毒耐药突破率仅为3.1%(1例),B组HBV-DNA<103cp/ml者占53.3%,HBeAg阴转率为23.3%,病毒耐药突破率为16.6%(5例);两组血清透明质酸酶、Ⅲ型前胶原、层粘连蛋白、Ⅳ型胶原治疗后均明显降低(P<0.01),无明显不良反应出现。结论阿德福韦酯联合拉米夫定治疗代偿期乙型肝炎肝硬化,可迅速抑制HBV-DNA的复制,促进肝功能恢复,病毒突破率低,安全性好。Objective To observe the clinical efficacy and safety of post hepatitis B liver cirrhosis treated with adefuvir dipivoxil combined with lamivudine or lamivudine alone.Method Sixty two cases of post hepatitis B liver cirrhosis were divided into two groups.During a treatment course of 48 weeks,group A（32cases） was treated by adefuvir dipivoxil tablets 10 mg/d and lamivudine tablets 100 mg/d,and group B （30 cases） was treated with lamivudine tablets 100 mg/d.Besides,both groups were coupled with routine support of the hepatic functions and symptomatic treatment.The index of ALT,AST,TBIL,ALB,HA,LN,PCⅢ,C-Ⅳ,PTA,HBV-DNA,HBeAg,anti-HBe were tested before and 12,24,48 weeks after treatment.At the same time,renal function and adverse drug reactions of patients were monitored.Result After 48 weeks treatment,ALT,AST,TBIL,HA,LN,PCⅢ,C-Ⅳ decreased significantly than before（P〈0.01）,while ALB and PTA significantly increased（P〈0.01） in two groups.The negative rates of HBV-DNA and HBeAg were 62.5 %,37.5% separately,and 1 patient（3.1%） rebound in virology occurred in group A.The negativity rates of HBV-DNA and HBeAg were 53.3 %,23.3% separately,and 5 patients （16.6%） rebound in virology occurred in group B.All cases had no treatment-related renal dysfunction and severious adverse reactions.Conclusion Adefuvir dipivoxil combined with lamivudine treatment of post hepatitis B liver cirrhos is effective,safety and low virus mutation rate,through the rapid HBV suppression and recovering hepatic functions.

关 键 词：乙型肝炎 代偿期肝硬化 阿德福韦酯 拉米夫定 

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