替比夫定与阿德福韦酯治疗乙型肝炎肝硬化疗效  

Comparison of Curative Effects of Tlbivudine and Adefovir Dipivoxil in Treating Hepatitis B Cirrhosis

作　　者：王晓霖[1,2] 张安斌[3] 杨京[4] 

机构地区：[1]襄樊市中心医院消化2科,湖北襄樊441021 [2]贵阳医学院 [3]襄樊市中心医院风湿科,湖北襄樊441021 [4]贵阳医学院附院感染科,贵州贵阳550004

出　　处：《贵阳医学院学报》2014年第3期392-396,共5页Journal of Guiyang Medical College

摘　　要：目的:比较替比夫定(LDT)与阿德福韦酯(ADV)治疗乙型肝炎肝硬化的临床效果。方法:将120例乙型肝炎肝硬化患者随机分成LDT组和ADV组,两组在采用常规保肝对症治疗的基础上分别用LDT及ADV治疗,疗程均为96周;观察治疗前及治疗后12、48、96周时两组患者的病毒学指标、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、白蛋白(ALB)、肌酐(cr)、尿素氮(BUN)、凝血酶原时间(PT)、外周血T淋巴细胞亚群及ChildPugh分级。结果:治疗12、48、96周时,LDT组HBV-DNA阴转率分别为50%、60%、80%,明显高于ADV组(分别为13%、40%、60%),差异有统计学意义(P<0.05);治疗48和96周时LDT组患者血清HBeAg阴转率(分别为40%、47%)及HBeAg/抗HBe转换率(25%、30%)明显高于ADV组(HBeAg阴转率为18.3%、25%,HBeAg/抗HBe转换率为10%、15%),差异有统计学意义(P<0.05);在治疗96周时,LDT组ALT、TBil、PT、cr、BUN明显低于ADV组,ALB、CD4+及CD4+/CD8+比值明显高于ADV组(P<0.05);Child-Pugh分级改善,与ADV组比较差异有统计学意义(P<0.05)。结论:替比夫定治疗乙型肝炎肝硬化与阿德福韦酯比较、能更有效抑制病毒复制,改善肝、肾功能、凝血指标及Child-Pugh分级,并能提高患者免疫功能。Objective： To compare the clinical efficacy of telbivudine （LDT） and adefovir dipivoxil （ADV） in treating hepatitis B cirrhosis. Methods： A total of 120 patients with hepatitis B cirrhosis were randomly divided into group LDT and group ADV. Besides of conventional treatment, patients in the two groups were given LDT and ADV for 96weeks respectively. Virological indicators, serum levels of alanine aminotransferase （ ALT）, total bilirubin （ TBil）, albumin （ ALB ）, creatinine （ cr）, urea ni- trogen （BUN） and prothrombin time （PT）, and T lymphocyte subsets in peripheral blood and Child- Pugh grading of patients in the two groups were detected before treatment and in 12,48 and 96 weeks after treatment. Results： In 12,48 and 96 weeks after treatment, the HBV-DNA negative conversion rates of group LDT were 50%, 60%, and 80%, which were significantly higher than those of group ADV （13%, 40%, and 60% respectively） （P 〈 0. 05） . In 48 and 96 weeks after treatment, HBeAg negative conversion rates of group LDT were 40%, and 47%, which were significantly higher than those of group ADV （ 18.3% , 25% ） respectively, and HBeAg/anti-HBe conversion rates ofgroup LDT were 25%, 30%, which were higher than those of group ADV （respectively 10%, 15% ）, and the difference was statistically significant （P 〈 0.05 ） . In 96 week after treatment, in group LDT, the ALT, TBiL, PT and cr levels were significantly lower than in group ADV, and ALB level, CD4 ＋ cell counts, and CD4 ＋/CD8＋ cell ratio were significantly higher than in group ADV （P 〈 0.05 ） ; The Child-Pugh grading in group LDT were improved after treatment （ P 〈 0.05 ）, compared with group ADV. Conclusions： Compared with ADV, LDT can more effectively inhibit virus liver function, kidney function, prothrombin time, Child-Pugh grading and immune copy and improve function.

关 键 词：替比夫定 阿德福韦酯 肝炎 乙型 肝硬化 肝功能试验 病毒学指标 淋巴细胞亚群 

分 类 号：R512.62[医药卫生—内科学]