乙型肝炎肝硬化失代偿期患者抗病毒治疗疗效分析.docx

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乙型肝炎肝硬化失代偿期患者抗病毒治疗疗效分析

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【摘要】目的比较恩替卡韦（ETV）与阿德福韦酯（ADV）联合拉米夫定（LAM）治疗乙型肝炎肝硬化失代偿期患者的疗效。方法57例失代偿期乙型肝炎肝硬化被随机分为A、B两组。其中A组29例接受ETV抗病毒治疗，B组28例接受ADV+LAM抗病毒治疗，观察治疗前后患者的临床症状、肝、肾功能、病毒学标志物变化及Child-Paugh评分。结果54例患者按要求完成治疗，其中A组1例，B组2例未完成治疗而列为失败。治疗结束后2组在的肝功能得到明显改善，Child-Paugh评分明显下降，与治疗前相比差异显著（p0.05),但2组治疗后比较无显著性差异（p0.05)。治疗结束后A组患者的HBV-DNA阴转率、HBeAg阴转率及HBeAg血清学转换率均高于B组，但2组比较无显著性差异（p0.05)。结论ETV与LAM+ADV治疗失代偿期乙型肝炎肝硬化均能明显改善肝功能,不同程度地逆转肝硬化，疗效确切。

【关键词】肝炎乙型慢性肝硬化失代偿期恩替卡韦阿德福韦酯拉米夫定

R512.6+2A2095-1752（2012）36-0103-02

TheefficacyofantiviraltherapapyforhepatitisBvirusrelateddecompensatedcirrhosisLISu-ping,ZHANGXiao-li.DepartmentofInfectiousDiseases,TheHeadQuartersofHospitalinCoalPropertyGroup,Yangquan045000,China

【Abstract】ObjectiveTocomparetheefficacyofEntecavir(ETV)andlamivudine(LAM)combinationtherapywithAdefovirDipivoxil(ADV)forpatientswithhepatitisBvirus(HBV)-relateddecompensatedcirrhosis.MethodsFifty-sevenpatientsofHBV-relateddecompensatedcirrhosiswerepidedinAGroup(29cases)andBgroup(28cases).ThepatientsinAgroupreceivedETVandBGroupreceivedLAMcombinedwithADV.Theclinicalsymptoms,Liverandkidneyfunction,HBV-DNA,HBeAg/antiHBeorChild-Pughdegreescoresweredetectedbeforeandaftertreatments.Results54casescompletedthewholecourseoftreatmentexceptfor3cases(oneinGroupAandtwoinGroupB).Comparedwithpre-treatment,Afterthetreatment,liverfunctionwasimproved,Child-Pughdegreescoresofthetwogroupsdecreased,whilethecomparisonbetweenthetwogroupafterthetreatmentwasnotsignificantlydifferent（p0.05).Afterthetreatment,HBV-DNAnegativeconversion,portionofHBeAglossrateandHBeAgseroconversionratewashigherinAGroupthanBGroup,Butthecomparisonbetweenthetwogroupwasnotsignificantlydifferent（p0.05).ConclusionETVandLAMcombinedwithADVhavecurativeeffectonHBV-relateddecompensatedcirrhosis,andtheycannotonlyimproveliverfunction,butalsochangeoverthecirrhosisatdifferentdegrees.

【Keywords】HepatitisBchronicLivercirrhosisdecompensatedEntecavirAdefovirdipivoxilLamivudine

失代偿期乙型肝炎肝硬化，属晚期肝病，并发症多，预后极差。据统计，肝硬化代偿期5年的生存率为86%，但如果进展至肝硬化失代偿期，5年的的生存率