抗病毒药物治疗代偿期乙型肝炎肝硬化的效果及对预后的影响  

Influence of antiviral treatment on the efficacy and prognosis of compensated Hepatitis B cirrhosis

作　　者：刘玉玲[1] 张国顺[1] 徐晓平[1] 李姗姗[1] 马宁[1] 闫杰[1] 尚华[2] 

机构地区：[1]河北联合大学附属医院消化内科,唐山063000 [2]唐山市传染病医院

出　　处：《中国综合临床》2013年第2期138-141,共4页Clinical Medicine of China

基　　金：唐山市科学技术研究与发展计划项目（12140209A-53）

摘　　要：目的观察抗病毒药物治疗乙型肝炎肝硬化代偿期患者的现状、疗效及对预后的影响。方法将865例乙型肝炎肝硬化代偿期患者随机分组。在保肝对症治疗的基础上分别给予干扰素（A组143例，300万u，1次／隔日，皮下注射，疗程48周）、拉米夫定（B组171例，100mg／d，口服，疗程48周）、阿德福韦（C组137例，10mg／d，口服，疗程48周）、思替卡韦（D组83例，0．5mg／d，口服，疗程为48周）。同时设立保守非抗病毒治疗组（E组，331例，仅用一般保肝药物，疗程不限）。观察所有患者临床症状、体征、肝功能变化、凝血酶原时间活动度（PTA），HBV—DNA定量、HBeAg阴转、HBeAg／HBeAb转换情祝。结果治疗48周及随访结束时，A组HBeAg血清转换率（分别为31．5％、33．1％）高于B、C、D、E组（分别为13．5％、22．6％、18．1％、5．7％与14．2％、23．3％、23．6％、6．4％），差异有统计学意义（X^2值分别为58．56、52．87，P均〈0．01）。A、B、C、D各组病情进展较慢，失代偿肝硬化发生率明显低于E组（X^2=122．41，P〈0．叭）。A组肝癌发生率明显低于E组及B、C、D组（X^2=19．61，P〈0．01）。结论干扰素和核苷类药物抗病毒治疗能减缓代偿期乙型肝炎肝硬化病情进展和失代偿肝硬化发生率；干扰素可明显降低代偿期乙型肝炎肝硬化的肝癌发生率。Objective To analyze the efficacy and prognosis of different antiviral agents on compensated hepatitis B cirrhosis. Methods Eight hundred and sixty-five cases of Hepatitis B patients with compensated cirrhosis were randomly divided into five groups ：A group（ n = 143, subcutaneous injection interferon 3 million U every other day for 48 weeks） ,B group（ n = 171 ,orally treatment with lamivudine 100 mg/d for 48 weeks ）, C group （n = 137, orally treatment with adefovir 10 mg/d for 48 weeks）, D group（ n = 83, oral treatment with entecavir 0. 5 rag/d, for 48 weeks ） and E grouD （ n = 331. treated with general heoatonroteetive drugs ）.Clinical symptoms and signs, changes in liver function were observed and prothrombin time activity degrees （PTA）, quantitative HBV-DNA, HBeAg seroconversion and HBeAg/HBeAb conversion situation were detected. Results There were significant differences on HBeAg seroconversion between A group and other four groups after treated for 48 weeks（31.5% vs 13.5% ,22. 6% ,18. 1% ,5.7% X^2 =58.56,P 〈0. 01 ） and at the end of follow up（33. 1% vs 14. 2 % ,23. 3 % ,23.6%, 6. 4%, X2 = 52. 87, P 〈 0. 01 ）. Patients＇ condition in A, B, C, D groups progressed slowly, and their incidence rates of decompensate cirrhosis were significantly lower than that in group E （ X^2 = 122.41, P 〈 0. 01 ）. The incidence rate of liver cancer in group A was significantly lower than that in B,C,D,E groups（X^2 = 19. 61 ,P 〈0.01 ）. Conclusion Antiviral therapy of interferon and nucleoside drugs can slow the progression of compensated Hepatitis B cirrhosis and reduce the incidence rates of decompensate cirrhosis. And interferon can significantly reduce the incidence rate of liver cancer.

关 键 词：肝硬化 抗病毒药 预后 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]