拉米夫定或阿德福韦酯选择性治疗失代偿性乙型肝炎肝硬化3年临床观察  

Outcome of selecting lamivudine or/and adefovir dipivoxil for treatment of decompensated cirrhosis patients infected chronic hepatitis B:a 3-year′s clinical course

作　　者：肖扬[1] 郑金莉[1] 周岳进[1] 胡侠[1] 张文静[1] 卢成鸿[1] 潘华将[1] 

机构地区：[1]浙江温州解放军第一一八医院肝病科,325000

出　　处：《肝脏》2010年第1期1-4,共4页Chinese Hepatology

摘　　要：目的观察拉米夫定或阿德福韦酯选择性治疗乙型肝炎肝硬化失代偿期患者长疗程疗效及治疗方案的选择。方法乙型肝炎肝硬化失代偿期患者65例,HBV DNA>5 log10拷贝/mL者服用拉米夫定(100mg/d)或再联用阿德福韦酯(10mg/d);HBV DNA<5 log10拷贝/mL者可单用拉米夫定或阿德福韦酯;病毒持续不下降或反弹要求拉米夫定联用阿德福韦酯。观察治疗前后患者临床症状体征、生化指标、病毒学改变情况。结果65例患者中43例生存至研究结束,3年生存率为66.1%。患者治疗后肝功能正常或好转,病情缓解稳定,生活质量改善,HBV DNA下降约3 log10拷贝/mL,Child-Pugh积分下降>3。结论拉米夫定或阿德福韦酯选择性治疗乙型肝炎肝硬化失代偿期患者,可延长患者生存时间,改善肝功能,阻止病情进展,提高生活质量。Objective To evaluate the efficiency of lamivudine or/and adefovir dipivoxil for the treatment of decompensated cirrhosis patients with chronic hepatitis B（CHB）.Methods Sixty-five decompensated cirrhosis patients were assigned into two groups based on the HBV DNA loads.Patients whose viral DNA ≥5 log10 copies/mL received lamivudine 100 mg/d or/and adefovir dipivoxil（ADV,10 mg/d）.The remaining patients（HBV DNA 5 log10 copies/mL） were treated with 10 mg/d ADV monotherapy.Patients who resisted with the single ADV treatment were boosted with the combination of lamivudine and ADV.The efficiency was determined by comparison of clinical manifestations,biochemical inder and viral loads pre-and post treatment.Results Total 43 patients after treatment of lamivudine and ADV showing clinical symptoms and liver function improved,Child-Pugh score and HBV DNA decreasing（3 log10copies/mL）.The survive rate for 3-year was 66.1%.Conclusion The present study confirmed lamivudine or/and ADV was effective for the treatment of decompensated cirrhosis patients.

关 键 词：慢性乙型肝炎 失代偿性肝硬化 治疗学 拉米夫定 阿德福韦酯 

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