多种核苷类似物单药和联合用药治疗失代偿期乙型肝炎肝硬化对比研究.docVIP

多种核苷类似物单药和联合用药治疗失代偿期乙型肝炎肝硬化对比研究 　　【摘要】 目的 比较恩替卡韦（ETV）、阿德福韦酯（ADV）、拉米夫定（LAM）单药或联合用药治疗失代偿期乙肝肝硬化的临床疗效。方法 失代偿期乙肝肝硬化患者120例，随机分为A、B、C、D共4组，分别口服ETV、ADV、LAM联合ADV、对照组。治疗48周，检测治疗前后HBV DNA、肝功能、Child-Pugh评分。结果 4组患者基线无统计学差异，具有可比性（P0.05）。4组患者治疗前后HBV DNA、ALT、AST、TBIL、Child-Pugh评分下降，白蛋白、PTA上升，A、B、C组治疗前后比较差异有统计学意义（P0.05）。48周时，HBV DNA水平、ALT、AST、TBIL、Child-Pugh评分降低，白蛋白升高，HBV DNA阴转率比较，A、C组差异无统计学意义（P0.05），均优于B组（P0.05）。结论 ETV、ADV、LAM单药或联合用药治疗失代偿期乙肝肝硬化能抑制病毒，改善肝功能，安全性好。治疗48周，ETV、LAM联合ADV治疗疗效相似，均优于单用ADV。? 　　【关键词】 恩替卡韦； 拉米夫定； 阿德福韦酯； 乙肝； 肝硬化?? 　　Comparison of efficacy of nucleot(s)ide analogues in patients with hepatitis B virus-induced decompensated cirrhosis YANG Jing, FAN Hui-zhen. The People?s Hospital of Yichun City in Jiangxi Province, Yichun 336000, China? 　　【Abstract】 Objective To analyze the efficacy of nucleot(s)ide analogues including lamivudine, adefovir, entecavir in treatment of patients with HBV-induced decompensated cirrhosis.Methods 120 cases of HBV-induced decompensated cirrhosis were randomly divided into four groups. HBV DNA, liver function and Child-Pugh scores were observed at different time points.Results The baseline characteristics of the groups were comparable by age, gender, Child-Pugh scores and HBV DNA levels（P0.05）. After 48 weeks therapy, the HBV DNA, ALT, AST, TBIL, Child-Pugh scores, ALB and PTA had significant improvement compared with baseline values in the A, B and C groups (P0.05) and had no improvement in group D. The differences of the mean level of HBV DNA, ALT, AST, TBIL, Child-Pugh scores, ALB and the rates of undetectable HBV DNA were statistically significant between the group A and group B, group B and C, respectively. There was no significant difference between the group A and C.Conclusion Nucleot(s)ide analogues results in suppression of HBV and improvement of liver function and Child-Pugh score in the patients with decompensated cirrhosis. The efficacy of ETV and combination therapy is similar after 48 weeks therapy and they have an advantag