替比夫定治疗乙型肝炎肝硬化患者48周临床观察  

Therapeutic effects of 48-week telbivudine treatment in patients with cirrhosis caused by HBV

作　　者：赵文莉[1] 王保春[1] 黄飞[1] 

机构地区：[1]荆州市中心医院感染科,湖北荆州434020

出　　处：《临床肝胆病杂志》2011年第8期840-843,共4页Journal of Clinical Hepatology

摘　　要：目的观察替比夫定治疗乙型肝炎肝硬化患者48周疗效。方法采用随机、对照队列研究方法,将93例乙型肝炎肝硬化患者分成三组,替比夫定(LDT)组32例,拉米夫定(LAM)组31例,对照组30例,采用常规保肝对症治疗,疗程均为48周。观察治疗不同时间点患者的病毒学、生化学、凝血酶原时间(PT)、肝纤维化指标及Child-Pugh计分等变化情况。结果 LDT组患者HBV DNA水平显著下降,HBV DNA转阴率优于LAM组和对照组,差异均有统计学意义(P<0.05)。在24和48周LDT组患者血清HBeAg阴转率及HBeAg/抗-HBe血清学转换率与对照组比较,差异有统计学意义(P<0.05)。ALT、AST、TBil明显下降,肝纤维化指标改善,Child-Pugh计分下降,在24和48周,LDT组和LAM组较治疗前比较差异有统计学意义(P<0.05)。结论 LDT治疗乙型肝炎肝硬化患者能有效、快速抑制病毒复制,改善肝功能、肝纤维化指标及Child-Pugh计分等。Objective To observe the therapeutic effects of 48 - week telbivudine treatment in patients with cirrhosis caused by hepatitis B virus（HBV）. Methods In this cohort study, 93 patients with liver cirrhosis caused by HBV were divided into three groups randomly： telbivudine （LDT） group （n =32）, lamivudine （LMV） group （n = 31 ）, and control group （n = 30）： conventional liver protection treatment. The course of treatment lasted 48 weeks. The virological and biochemical parameters, PT, hepatic fibrosis index and Child -Pugh score were observed at different time points during treatment. Results The HBV DNA levels in telbivudine group were significantly decreased. The negative rates of HBV DNA （ 〈 500 copies/ml） were correspondingly and significantly higher than those in lamivudine group and control group （P 〈0. 05 ）. At week 24 and 48, the negative rates of hepatitis B e antigen（HBeAg） and the rates of HBeAg/anti -HBe sero -conversion in telbivudine group were significantly higher than those in control group （P 〈 0.01 ）. ALT, AST, total bilirubin, hepatic fibrosis index and Child - Pugh score were significantly improved in telbivudine group and lamivudine group after treatment （P 〈 O. 05）. Conclusion Telbivudine can rapidly and effectively inhibit HBV DNA replication and improve liver function, hepatic fibrosis index and Child - Pugh score in patients with liver cirrhosis caused by HBV.

关 键 词：肝炎 乙型 慢性 肝硬化 拉米夫定 替比夫定 

分 类 号：R512.62[医药卫生—内科学]