阿德福韦酯与替比夫定联合恩替卡韦对失代偿期乙肝肝硬化患者肝功能及血清病毒学指标的影响  

Influence of adefovir dipivoxil versus telbivudine combined with entecavir on liver function and serum virology in hepatitis B patients with decompensated liver cirrhosis

作　　者：张伟[1] 许荣放 田锐锋[1] 王九萍[1] 

机构地区：[1]第四军医大学西京医院感染科,西安710032

出　　处：《解放军医学杂志》2016年第12期1041-1044,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察阿德福韦酯与替比夫定联合恩替卡韦对失代偿期乙肝肝硬化患者肝功能及血清病毒学指标的影响。方法选取第四军医大学西京医院2014年2月-2015年4月收治的80例失代偿期乙肝肝硬化患者,按治疗方式分成2组(每组40例),观察组用替比夫定联合恩替卡韦治疗,对照组用阿德福韦酯治疗,观察两组患者12、24、48周时的肝功能、血清病毒学指标及不良反应发生情况。结果治疗前观察组丙氨酸转氨酶(ALT)、白蛋白(ALB)、总胆红素(Tbil)、凝血酶原活动度(PTA)及Child-Pugh评分与对照组比较差异无统计学意义(P>0.05);随治疗时间延长,两组ALT、TBil值及Child-Pugh评分逐渐降低,ALB和PTA值逐渐上升,与治疗前比较差异有统计学意义(P<0.05)。治疗后同一时期比较,观察组ALT、Tbil和Child-Pugh评分均低于对照组(P<0.05),ALB、PTA值均高于对照组(P<0.05)。治疗后同一时期观察组HBV DNA及HBe Ag转阴率明显高于对照组(P<0.05)。结论恩替卡韦联合替比夫定治疗失代偿期肝硬化的疗效优于阿德福韦酯,患者肝功能恢复快,血清病毒学指标转阴率高,不良反应低,值得在临床上推广。Objective To investigate the influence of adefovir dipivoxil （ADV） versus telbivudine （LdT） combined with entecavir （ETV） on liver function and serum virology of hepatitis B patients with decompensated liver cirrhosis （DLC）. Methods Eighty DLC patients in our hospital from February 2014 to April 2015 were selected and divided into two groups （40 in each group）. Observation group was given LdT combined with ETV, control group was given ADV. The liver function and serum virology were observed 12, 24, 48 weeks after treatment in the two groups. Results Before treatment, the expression level and Child-pugh score between observation group [ALT（156.3 ± 50.2）U/L, ALB （30.5 ± 3.8）g/L, TBil （60.4 ± 23.1）μmol/L, PTA （40.3% ± 7.8%）, and Child-pugh score （11.3 ± 1.5） points] and control group [ALT （154.1 ± 51.4）U/L, ALB （31.3 ± 4.2）g/L, TBil （58.9 ± 24.3）μmol/L, PTA （42.1% ± 8.4%）, and the score （11.2 ± 2.0） points] were compared with no statistically significant difference between the two groups （P〉0.05）; after a period of treatment, ALT, TBil and Child-pugh score decreased gradually, while ALB and PTA increased gradually in the two groups, and the difference was statistically significant compared to the pretreatment （P〈0.05）. With the passage of time, ALT~ TBil and Child-Pugh score were lower, while ALB and PTA higher in the observation group than in control group, and the difference was statistically significant （P〈0.05）. At the same period after treatment, the negative conversion rates of HBV- DNA and HBeAg were obviously higher in the observation group than in the control group （P〈0.05）. Conclusion LDT combined with ETV in treating decompensated hepatitic cirrhosis has better effect than ADV does. Liver function recovered quicker, negative conversion ratio is higher, adverse reaction is less and LDT plus ETV is worthy of wide application.

关 键 词：肝炎  乙型  慢性 肝硬化 阿德福韦酯 替比夫定 恩替卡韦 

分 类 号：R512.62[医药卫生—内科学]