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机构地区:[1]晋城市人民医院消化内科,山西晋城048000
出 处:《现代医药卫生》2012年第19期2886-2887,2890,共3页Journal of Modern Medicine & Health
摘 要:目的观察核苷类药物治疗乙型肝炎肝硬化失代偿期的疗效。方法将83例乙型肝炎肝硬化失代偿期患者随机分为四组。所有患者在保肝、对症治疗的基础上,分别给予拉米夫定(A组)100 mg/d、阿德福韦酯(B组)10 mg/d、恩替卡韦(C组)0.5 mg/d口服,对照组(D组)仅给予保肝、对症治疗。观察所有患者临床症状、体征、肝功能、凝血酶原时间活动度(PTA)、乙型肝炎病毒(HBV)DNA定量、乙型肝炎e抗原(HBeAg)转阴情况等。结果在抗病毒治疗过程中,A组患者死亡2例,另1例在治疗过程中出现YMDD[酪氨酸(Y)、蛋氨酸(M)、2个天冬氨酸(D)]变异及时加用阿德福韦酯退出观察;B组患者死亡1例;C组患者无一例死亡;D组疗效最差,死亡4例。A、B、C组患者临床表现、肝功能及血清病毒学指标均较D组有明显改善,差异有统计学意义(P<0.01)。结论乙型肝炎肝硬化失代偿期患者应给予抗病毒治疗,可首选恩替卡韦,亦可选用阿德福韦酯或拉米夫定。Objective To observe the effect of nucleoside analogues in treating the decompensation stage of hepatitis B cirrhosis. Methods Eighty-three patients with the decompensation of hepatitis B cirrhosis were randomly divided into four groups. All were treated by the basic hepatoprotective and symptomatic treatment. The group A, B and C were separately given o- ral lamivudine (100 mg/d),adefovir (10 mg/d) and enteeavir(0.5 mg/d). The group D as control was given bepatoprotective and symptomatic treatment alone. The clinical symptoms, signs, change of liver function, PTA, quantitative HBV DNA, HBeAg nega- tive-conversion were observed among 4 groups. Results During antiviral treatment,2 cases in the group A died, 1 cases of the variation of tyrosine (Y), methionine (M) and two aspartates (DD) occurred and exited from observation after adding adefovir. The group B had 2 cases of death and the group C had no death. The group D had 4 cases of death, showing worst effect.The clinical manifestations,liver function and serum virological indicators in the group A ,B and C were improved more obviously than the group D with statistical difference(P〈0.01 ). Conclusion The patients with the decompensation stage of hepatitis B cirrhosis should accept the antiviral treatment. Entecavir can be used as first choice. Adefovir or lamivudine can be selected and used too.
关 键 词:肝硬化/药物疗法 拉米夫定/治疗应用 鸟嘌呤/类似物和衍生物 腺嘌呤/类似物和衍生物 恩替卡韦 阿德福韦酯 治疗结果 对比研究
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