乙型肝炎肝硬化抗病毒治疗48周的临床疗效  

Therapeutic effects of 48-week antiviral treatment in patients with hepatitis B virus related cirrhosis

作　　者：林淑珍[2] 徐启桓[1] 舒欣[1] 揭育胜[1] 陈旎[1] 谢奇峰[1] 李刚[1] 

机构地区：[1]中山大学附属第三医院感染科,广州510630 [2]广东省东莞市厚街医院感染科进修医师,523945

出　　处：《中华传染病杂志》2010年第3期164-167,共4页Chinese Journal of Infectious Diseases

摘　　要：目的观察核苷类药物对乙型肝炎肝硬化患者的抗病毒疗效及安全性。方法采用队列研究，将143例乙型肝炎肝硬化患者分为治疗组73例和对照组70例，两组患者的基线情况相当。治疗组在常规治疗的基础上加用核苷类药物抗病毒治疗48周，其中恩替卡韦30例、阿德福韦酯25例、拉米夫定16例、替比夫定2例；对照组给予常规治疗。两组间率的比较采用x2检验或Fisher确切概率法检验，均数比较采用t检验。结果治疗48周后，治疗组与对照组相比，AST、ALT、TBil明显下降，Alb及胆碱酯酶明显上升，差异有统计学意义（t=4．020、2．410、2．067、-5．369、3．713，均P％0．05）。治疗组HBVDNA转阴率为93．2％，高于对照组的2．9％，差异有统计学意义（t=116．6，P=0．001）。治疗组及对照组的HBeAg转阴率分别为65．4％及19．0％，差异有统计学意义（t=10．091，P=0．001）。治疗组腹膜炎发生率低于对照组（1．37％比11．43％，P一0．016）。治疗组无肝细胞癌发生，对照组有4例，差异无统计学意义（P=0．055）。治疗组消化道出血5例，占6．85％，对照组8例，占11．43％，差异无统计学意义（x2=0．907，P=0．341）。治疗组中1例采用拉米夫定治疗的患者在42周出现病毒学反弹，HBeAg由阴性转为阳性，肝功能恶化死亡，对照组2例死亡，两组病死率比较差异无统计学意义（p=0．614）。结论核苷类药物能改善乙型肝炎肝硬化患者的肝功能，降低HBV复制，提高HBeAg转阴率。治疗过程中须密切观察病毒变异耐药情况，防止肝功能恶化。Objective To evaluate the efficacy and safety of nucleoside（s） analogues in patients with hepatitis B virus （HBV） related cirrhosis. Methods In this cohort study, 143 patients with HBV related cirrhosis were divided into treatment group （73 cases） and control group （70 cases）. Age, gender, liver function and Child Pugh score in two groups were comparable. In treatment group, patients were treated with nucleoside（s） analog for 48 weeks on the basis of conventional therapy, including 30 cases treated with entecavir, 25 with adefovir dipivoxil, 16 with lamivudine and 2 with telbivudine. Patients in control group were treated with conventional therapy only. Comparison of g rates between two groups were done by X test or Fisher^s exact test, and means were compared by t test. Results At week 48 of treatment, levels of aspartate transaminase （AST）, alanine amiotransferase （ALT） and total bilirubin （TBil） in treatment group decreased more significantly than those in control group （t=4.020, P=0.001; t=2. 410, P=0. 018;t=2. 067, P 0. 042, respectively） . levels of albumin （Alb） and cholinesterase （CHE） in treatment group increased more significantly than those in control group （t =--5. 369, P= 0.001 t =-3. 713, P = 0.006, respectively）. At week 48, the negative rate of HBV DNA in treatment group was 93.2 %, which was significantly higher than that in control group （2. 9 %, t = 116.6, P = 0. 001）. The negative rate of hepatitis B e antigen （HBeAg） in treatment group was 65.4%, which was higher than that in control group （19.0 %, t= 10. 091, P= 0. 001）. The incidence of spontaneous peritonitis in treatment group was lower than that in control group （1. 37% vs 11. 43%, P= 0. 016）. No patient developed hepatocellular carcinoma （HCC） in treatment group while 4 out of 70 patients developed HCC in eontrolgroup （P〈0. 055）. Five patients （6.85%） in treatment group and 8 （11.43%） in control group developed gastrointestinal hemorrhage, which were not

关 键 词：肝炎病毒 乙型 肝硬化 核苷类 抗病毒药 变异(遗传学) 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]