拉米夫定与阿德福韦酯在失代偿期乙型肝炎肝硬化患者中的联合应用研究  

The Application of Combined Lamivudine and Adefovir in the Treatment of Patients with Decompensated Period Hepatitis HBV Cirrhosis

作　　者：杨鸿[1] 

机构地区：[1]重庆市第九人民医院感染科,重庆400700

出　　处：《河北医学》2013年第6期819-822,共4页Hebei Medicine

摘　　要：目的:探讨拉米夫定与阿德福韦酯在失代偿期乙型肝炎肝硬化患者中联合应用的临床治疗效果,为失代偿期乙型肝炎肝硬化患者的临床治疗提供可参考依据。方法:共纳入52例诊断为失代偿期乙型肝炎肝硬化患者,详细记录患者的基本信息及相关病史,采用随机数字法平均分为两组,A组患者给予拉米夫定联合阿德福韦酯治疗措施,B组患者给单独拉米夫定治疗措施。随访观察1年,并分别于治疗前、治疗后3月,治疗后6月及治疗后1年监测患者肝功能、肾功能指标、HBV-DNA水平,并进行Child-Pugh评分,比较两组患者的差异。结果:治疗后两组间肝功能指标比较,结果显示:治疗前两组患者ALT、ALB、TBil差异比较不明显(P>0.05);治疗后3月、6月、1年,两组患者ALT、TBil明显降低,ALB明显升高,差异比较有统计学意义(P<0.05);与B组(单独组)患者相比,A组(联合组)患者ALT、TBil下降更明显,ALB升高更明显,差异比较有统计学意义(P<0.05)。治疗后两组间HBV-DNA水平及Child-Pugh评分比较,结果显示:治疗前两组患者HBV-DNA水平及Child-Pugh评分差异比较不明显(P>0.05);治疗后3月、6月、1年,两组患者HBV-DNA水平及Child-Pugh评分明显降低,差异比较有统计学意义(P<0.05);与B组(单独组)患者相比,A组(联合组)患者HBV-DNA水平及Child-Pugh评分下降更明显,差异比较有统计学意义(P<0.05)。两种治疗方法治疗后,患者的肾功能Cr变化不明显,亦未出现其他明显的不良反应。结论:拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化有较好的临床疗效,可以更明显的改善患者的肝功能及降低HBV-DNA水平及Child-Pugh评分,且对患者的肾功能影响比较小,值得临床推广应用。Objective： To explore the effect of combined lamivudine and adefovir in the treatment of patients with decompensated period hepatitis HBV cirrhosis. Method： 52 patients with decompensated period hepatitis HBV cirrhosis were selected, they were divided into two groups by means of random digital method, the patients in group A were given therapy of combined lamivudine and adefovir, while in group B only received lamivudine. The indexes of liver function, renal function monitoring results, HBV-DNA level and Child - Pugh scores before the treatment and the 3th month, 6th month, and l year after the treatment were compared. Result： The indexes of ALT, ALB, TBil in both groups showed no significant difference before the treatment （P 〉 0.05）. The ALT and TBil decreased significantly at the time points of 3th month, 6th month, and l year after treatment, while the ALB increased significantly, the differences were statistical significance （ P 〈 0.05 ）. Compared with group B, the ALT and TBil of group A decreased, while the ALB increased, the differences were statistical significance （ P 〈 0.05 ）. The HBV - DNA level and Child - Pugh score showed no significant difference between both groups before the treatment （ P 〉 0.05 ）. The indexes of both groups decreased significantly at the time points of 3th month, 6th month, and lyear after treatment （P 〈 0.05 ）. Compared with group B, the indexes of group A decreased significant （ P 〈 0.05 ）. After treat- ment, The change of renal function clearance was not obvious, and no other obvious adverse reactions were observed. Conclusion： The therapy of lamivudine combined adefovir in the treatment of decompensated period hepatitis HBV cirrhosis, shows better clinical effect, can obvious improve the liver function and reduce HBV-DNA level and Child - Pugh score of the patients, it is worth clinical application.

关 键 词：拉米夫定 阿德福韦酯 失代偿期 乙型肝炎 肝硬化 

分 类 号：R512.62[医药卫生—内科学]