拉米夫定与阿德福韦酯初始联合与单药优化治疗代偿期乙型肝炎肝硬化的疗效比较  

Comparison of efficacy of lamivudine plus adefovir dipivoxil de novo combination therapy with optimization monotherapy in patients with decompensated hepatitis B cirrhosis

作　　者：张颖慧[1] 李良平[1] 张笛[1] 

机构地区：[1]四川省人民医院消化内科,成都610072

出　　处：《重庆医学》2017年第29期4077-4080,共4页Chongqing medicine

基　　金：四川省卫生厅基金资助项目(110184)

摘　　要：目的观察拉米夫定(LAM)与阿德福韦酯(ADV)初始联合与单药优化治疗代偿期乙型肝炎肝硬化的疗效,并分析抗病毒治疗早期应答的影响因素。方法选取2014年1月至2015年12月该院收治的乙型肝炎肝硬化患者158例,采用随机数字表法进行分组:联合组(81例)给予LAM初始联合ADV治疗;优化组(77例)初始单用LAM或ADV,至24周优化联合用药。比较两组的临床疗效,并分析抗病毒治疗24周完全应答的影响因素。结果治疗12周后,联合组乙型肝炎病毒(HBV)DNA载量下降水平高于优化组(P<0.05),但两组HBV DNA转阴率比较差异无统计学意义(P>0.05)。治疗24周后,联合组HBV DNA载量下降水平和转阴率及完全应答率均高于优化组,病毒学突破率低于优化组(P<0.05)。治疗48周后,联合组HBV DNA载量下降水平和转阴率、乙型肝炎e抗原(HBeAg)转阴率及血清学转换率均明显高于优化组,血清透明质酸和α2巨球蛋白水平均低于优化组(P<0.05);但两组丙氨酸氨基转移酶(ALT)复常率、完全应答率和病毒学突破率比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,抗病毒治疗24周完全应答与治疗前HBV DNA载量、HBeAg、治疗前ALT水平及初始治疗方案有关(P<0.05)。分层分析结果显示,无论治疗前HBV DNA载量高或低,HBeAg表达阳性或阴性及治疗前ALT水平高或低,联合组治疗24周完全应答率均明显高于优化组(P<0.05)。结论 LAM和ADV初始联合治疗代偿期乙型肝炎肝硬化可以降低病毒耐药性,提高早期应答率,具有更强的抗病毒能力,并能较好地改善肝功能,可能部分逆转肝硬化。Objective To compare the efficacy of lamivudine （LAM） plus adefovir dipivoxil （ADV） de novo combination therapy to optimization monotherapy for hepatitis B virus-related compensated cirrhosis,and analyze the prediction factors of early response of antivirus treatment. Methods A total of 158 cases of patients with hepatitis 13 virus-related compensated cirrhosis were selected and randomly assigned to combined group （n=81） and optimized group （n=77） according to randomized digital table. The patients in the combined group accepted LAM combined ADV. The patients in the optimized group were firstly treated with LAM or ADV,then they were given optimized therapy with ADV or LAM if they had poor response or virological breakthrough at week 24. The clinical efficacies were compared between the two groups, and the prediction factors of early response were analyzed. Results At week 12,the decline level of HBV DNA in the combined group was higher than that in the optimized group （P〈 0.05）, but no statistically significant difference was found in the negative transformation rate of HBV DNA between the two groups （P〉0. 418）. At week 24, the decline level of HBV DNA, rate of undeteetable HBV DNA and rate of complete response were higher than those in the optimized group,and rate of virological breakthrough was lower than that in the optimized group （P〈0.05）. At week 48, the decline level and negative transformation rate of HBV DNA,negative transformation rate and seroeonversion rate of HBeAg were higher than those in the optimized group,and serum levels of hyaluronie acid and a2-macroglobulin were lower than those in the optimized group （P〈0. 05）. There was no statistically significant difference in the recover rate of alanine aminotransferase （ALT） ,rate of complete response and rate of virological breakthrough between the two groups at week 48 （P〉0.05）. Logistic regression analysis showed that the complete response at week 24 was correlated with HBV DNA load, expression of HB

关 键 词：肝炎 乙型 肝硬化 拉米夫定 阿德福韦酯 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]