阿德福韦酯在治疗69例HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水中临床作用观察.docVIP

阿德福韦酯在治疗69例HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水中临床作用观察 　　[摘要] 目的 了解阿德福韦酯（ADV）在治疗HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水中的临床作用，为该疾病提供有效的内科治疗手段。方法 135例HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水患者被随机分为治疗组69例和对照组66例。两组均给予相同的常规内科治疗，治疗组加用ADV治疗。治疗期间观察所有病例的临床症状与体征；治疗前和治疗6个月后分别检测天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、HBV血清标志物和HBV-DNA等；并观察药物不良反应。 结果 治疗组的腹胀、乏力、腹水消失时间均小于对照组，差异均有统计学意义（t=4.589、6.845、5.880，均P0.05）。治疗6个月后，治疗组的HBV DNA转阴率高于对照组，差异有统计学意义（χ2=3.215，P0.05）。治疗组的AST、ALT、TBIL、Child-Pugh评分均低于对照组，差异均有统计学意义（t=3.774、5.623、5.120、3.159，均P0.05）。治疗组的显效率为27.5%，总有效率为65.2%，均高于对照组，差异均有统计学意义（χ2=11.256、4.070，均P0.05）。治疗期间ADV的不良反应发生率为7.2%（5/69）。 结论 ADV用于治疗HBeAg阳性失代偿期乙型肝炎所致肝硬化腹水，疗效显著，不良反应发生率低，具有较好的临床应用价值。 　　[关键词] 阿德福韦酯；失代偿期乙型肝炎；肝硬化腹水；HBeAg阳性 　　[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701（2015）08-0099-03 　　[Abstract] Objective To learn the clinical role of adefovir dipivoxil（ADV） in the treatment of HBeAg positive decompensated hepatitis B caused cirrhosis ascites； To provide an effective medical treatment for the disease. Methods All 135 cases with HBeAg positive decompensated hepatitis B caused cirrhosis ascites were randomly divided into 69 cases of treatment group and 66 cases of control group. The two groups were given the same routine medical treatment， the treatment group was also given ADV treatment. Clinical signs and symptoms of all cases were observed during the treatments； before and 6 months after treatment， aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， total bilirubin（TBIL）， serum HBV markers and HBV DNA were respectively detected； adverse drug reactions were observed during the treatment. Results The symptoms disappear times of abdominal distension， lack of power， ascites of treatment group were less than control group， the differences were statistically significant（t=4.589， 6.845， 5.880， P 　　[Key words] Adefovir dipivoxil； Decompensated hepatitis B； Cirrhosis ascites； HBeAg positive 　　我国的乙型肝炎发病率较高，失代偿期乙型肝炎治疗难度大，并发症多，临床预后较差，且乙肝病毒（Hepatitis B virus， HBV）活跃复制的失代偿期乙型肝炎肝会出现细胞炎症和肝组织纤维化，会进一步进展为肝硬化腹水、上消化道出血、肝