替比夫定治疗活动性乙型肝炎肝硬化的临床研究  

Telbivudine in the treatment of patients with hepatitis B virus-related cirrhosis

作　　者：江宇杰[1] 黄成[1] 石小枫[1] 

机构地区：[1]重庆医科大学附属第二医院感染科,重庆400010

出　　处：《重庆医科大学学报》2014年第7期1023-1026,共4页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:81270503)

摘　　要：目的:观察替比夫定治疗乙型肝炎肝硬化的临床疗效。方法:43例HBV DNA定量大于1×105拷贝/ml的乙型肝炎肝硬化患者入选此研究,23例予替比夫定600 mg/d;每3个月检测肝脏功能及HBV DNA的变化,同时与20例未抗病毒治疗病例进行比较。结果:随着治疗时间的延长,替比夫定治疗组患者各指标较治疗前及对照组均有明显的改善:HBV DNA在第4周降至4.83±0.70,天冬氨酸转氨酶、总胆红素和Child-pugh评分在第12周分别降至(55.19±22.48)U/L、(36.81±22.11)μmol/L、(6.65±1.94)分,丙氨酸转氨酶在第24周降至(63.67±19.52)U/L,差异均具有统计学意义(P<0.05),但白蛋白改善不明显,替比夫定组治疗2例病例于治疗的24周和36周出现病毒学突破,经检测为rtM204I突变,给予阿德福韦酯联合治疗。结论:替比夫定在改善乙型肝炎肝硬化患者肝脏功能及降低HBV DNA方面具有良好的临床疗效,但仍有较高的病毒耐药突变。Objective：To evaluate the clinical efficacy of telbivudine （LdT） in the treatment of patients with hepatitis B virus-related cirrhosis. Methods：A total of 43 patients with HBV DNA level more than 5 logl0 copies/ml were enrolled in this study：23 patients received LdT 600 mg orally daily（LdT group） and 20 patients received no antiviral treatment （control group）. Liver function and serum HBV DNA level were assessed every 3 months. Results：The parameters of liver function （alanine aminotransferase （ALT）, as- partate aminotransferase （AST）,total bilirubin （TBIL）, Child-pugh score）and serum HBV DNA level were significantly improved in LdT group compared with those in control group with the extension of the treatment（HBV DNA level was reduced to 4.83 ± 0.70 at the 4th week;AST,TBIL and Child-pugh score were reduced to （55.19 ± 22.48） U/L, （36.81 ± 22.11） μmol/L,6.65 ± 1.94 respec-tively at the 12th week;ALT was reduced to （63.67 ± 19.52） U/L at the 24th week）（P〈0.05）. The serum ALB level showed no remarkable change in LdT group than in control group. Two patients in LdT group experienced virological breakthrough after 24 and 36 weeks（rtM204 mutations） and were salvaged treat-ment with adefovir dipivoxil. Conclusion： LdT suppresses viral replication and improves liver function in patients with chronic hepatitis B cirrhosis,but there is still a risk of emergence of LdT resistance.

关 键 词：替比夫定 乙型病毒性肝炎 肝硬化 

分 类 号：R575.2[医药卫生—消化系统]