替比夫定治疗失代偿期乙型肝炎肝硬化的临床观察  

The effect of Telbivudine therapy in patients with decompensated cirrhosis caused by HBV

作　　者：华建平[1] 马桂凤[1] 李春会[2] 李俊美[1] 邴玉芝[1] 张秋寅[1] 

机构地区：[1]天津市第一中心医院消化科,天津300192 [2]山东省千佛山医院,济南250014

出　　处：《临床肝胆病杂志》2010年第6期602-604,607,共4页Journal of Clinical Hepatology

摘　　要：目的观察替比夫定治疗失代偿期乙型肝炎肝硬化患者48周疗效。方法 64例乙型肝炎肝硬化患者分成两组,34例给予替比夫定600mg/d治疗,30例给予拉米夫定100mg/d,持续治疗48周。观察治疗后病毒学、生化学、凝血酶原时间及Child-Pugh计分等变化情况。结果替比夫定组患者血清HBV DNA对数值在治疗前为(5.35±0.58)log10拷贝/ml,在治疗后12、24、36、48w时血清HBV DNA下降值依次为(1.88±0.84)log10拷贝/ml,(2.11±0.84)log10拷贝/ml,(2.17±0.74)log10拷贝/ml,(2.36±0.57)log10拷贝/ml,相比拉米夫定组下降值有明显的统计学差异(P<0.05)。在治疗24周时ALT、AST明显下降,Alb、TBil、PT及Child-Pugh积分等指标均有所改善(P<0.05)。结论替比夫定治疗于失代偿乙型肝炎肝硬化患者在48周内即能快速有效抑制病毒复制,使HBV DNA水平明显下降,同时可以改善肝功能及Child-Pugh积分等指标。Objective To study the therapeutic efficacy of telbivudine in patients with decompensated cirrhosis resulting from chronic hepatitis B.Methods A total of 64 patients were divided into two groups,group one patients（n = 34） were received telbivudine 600mg and group two patients（n = 30） were treated with Lamivudine 100mg,orally per day for 48 weeks.The changes were observed at different times including virological and biochemical markers,PT and Child-Pugh score after antiviral therapy.Results In the telbivudine group,the mean serum HBV DNA level was（5.35 ± 0.58） log10 copies/ml,and the mean serum HBV DNA levels were（1.88 ± 0.84）,（2.11 ± 0.84）,（2.17 ± 0.74） and（2.36 ± 0.57） log10 copies/ml at 12,24,36 and 48 weeks,respectively.The mean reductions in serum HBV DNA levels were significantly greater in telbivudine group than lamivudine group（P 0.05）.After 24 weeks of therapy ALT,AST,albumin,total bilirubin and Child-Pugh scores were improved in the telbivdine group（P 0.05）.Conclusion Telbivudine rapidly and effectively inhibits the replication of HBV in cirrhosis resulting from chronic hepatitis B after 48-weeks of treatment and the reduction in the level of HBV DNA also improves the liver function,PT and Child-Pugh score.

关 键 词：肝炎 乙型 肝硬化 拉米夫定 替比夫定 

分 类 号：R575.2[医药卫生—消化系统]