拉米夫定治疗失代偿性乙型肝炎肝硬化的临床观察.doc

拉米夫定治疗失代偿性乙型肝炎肝硬化的临床观察 广东省阳江市人民医院感染科(529500)阮运河 ［摘要］目的：观察拉米夫定治疗失代偿性乙型肝炎肝硬化的疗效及安全性，探讨失代 偿性乙型肝炎肝硬化的抗病毒治疗策略。方法：回顾性总结分析拉米夫定连续治疗超过1年 且资料完整的64例失代偿性乙型肝炎肝硬化患者，观察治疗前后临床症状体征、生化指标、 血液学指标、病毒学指标改变情况及耐药发生情况。结果：拉米夫定治疗后，患者临床症状 及体征得到明显改善；血清ALT、AST及总胆红素下降，血清白蛋白含量增加，Ch订d-pugh 评分下降；外周血白细胞及血小板计数水平有明显增高；血清HBV DNA定量水平显著下降； 有耐药发生，但治疗1年内尚未见明显病情反跳。结论：乙型肝炎后肝硬化患者伴有活动性 病毒复制及肝炎时，长程拉米夫定治疗可有效阻止病情进展，提高生活质量。 ［关键词］慢性乙型肝炎，肝硬化，治疗学，拉米夫定 Treatment of hepatitis B virus (HBV) induced decompensated cirrhosis with lamivudine Ruan Yunhe, Department of Infectious Diseases, Yangjiang People 9 s Hospital, Guangdong province, China, 529500 ［Abstract］ Objective: To investigate the therapeutic effects and safety of long-term lamivudine treatment on decompensated cirrhosis following chronic hepatitis B, and to explore antivil strategies for HBV-induced decompensated cirrhosis. Methods: Sixty-four HBV-induced decompensated cirrhosis patients treated with lamivudine for more than 1 year were summarized and analyzed retrospectively. The virological, biochemical and hematological changes and clinical manifestations of the patients were observed before and after lamivudine treatment. ResuIts: After 1 year of lamivudine t reatment, the symp toms 且 nd signs of the pati ents tu rned bet ter greatly. During lamivudine treatment, serum ALT, AST and total bilirubin decreased, serum albumin increased, and Child-pugh grades decreased significantly and gradually. The counts of WBC and PLT in peripheral blood increased greatly. ConcI us i ons: Long-term lamivudine treatment for IIBV一induced decompensated cirrhosis is benificial for improving patients illness and life quality. [Key words] Chronic hepatitis B； Liver cirrhosis； Therapeutics； Lamivudine 拉米夫定(lamivudine, LAM)治疗慢性乙型肝炎的疗效及安全性已得到证实，病毒复制 活跃且肝功能代偿良好的慢性乙型肝炎是其最佳适应证。有资料显示，拉米夫定对于乙型肝 炎病毒(IIBV)复制活跃的失代偿性肝硬化有治疗作用，但尚缺乏严格的对照研究。为进一步 观察拉米夫定对丁失代偿性乙型肝炎肝硬化的治疗作用和安全性，2001年至今我们应用该药 治疗此类患者200余例，现将资料完整且疗程21年的64例疗效情况报道如下。 1 一般资料 64例患者中，男50例，女14例，平均年龄40. 1岁(21岁?69岁),根据病史、临床 表现、实验室检查、影像学检查及并发症等诊断