【摘要】 目的比较拉米夫定(LAM)与阿德福韦酯(ADV)初始联合或恩替卡韦(ETV)单药治疗失代偿期乙肝肝硬化患者1年的疗效。方法 60例失代偿期乙肝肝硬化接受初始拉米夫定与阿德福韦酯联合抗病毒治疗,40例接受恩替卡韦单药抗病毒治疗,每1～3月检测患者肝功能、肾功能、甲胎蛋白、乙肝三系、血清乙型肝炎病毒DNA、凝血酶原时间(PT)、肝脏的超声波或CT检查,在12个月比较疗效。结果 45例拉米夫定和阿德福韦酯初始联合组12个月血清HBV DNA阴转率为51.1%,而30例恩替卡韦单药治疗组HBV DNA阴转率为60.0%,两组比较均无显著性差异(P>0.05)。拉米夫定和阿德福韦酯初始联合治疗12个月HBeAg血清转换率达30.4%,恩替卡韦单药组HBeAg血清转换率26.7%,两组比较无显著性差异(P>0.05)。治疗12个月两组丙氨酸氨基转移酶(ALT)复常率相似。拉米夫定和阿德福韦酯初始联合组在治疗12个月时有2例(4.4%)发生病毒学突破,但均未检测到病毒学变异,恩替卡韦单药组在12个月时有1例(3.3%)发生病毒学突破。两种治疗手段均能明显改善肝功能,CTP评分和MELD评分有明显下降。随访12月,拉米夫定和阿德福韦酯初始联合治疗组累计死亡或肝移植率为9.4%,恩替卡韦单药组累计死亡或肝移植发生率为8.7%。两组均未发现有血清肌酐超过正常值上限的病例。结论拉米夫定与阿德福韦酯初始联合或恩替卡韦单药治疗失代偿期乙肝肝硬化患者均能明显抑制HBV复制,改善肝功能各项指标,降低病死率,值得临床应用。更多还原

【Abstract】 OBJECTIVE To compare the efficacy of lamivudine(LAM) combined with adefovir dipivoxil(ADV) de novo and entecavir(ETV) monotherapy in treatment of patients with hepatitis B virus(HBV)-related decompensated cirrhosis for one year.METHODS Sixty HBV-infected patients with decompensated cirrhosis treated with LAM combined with ADV de novo and 40 patients treated with ETV were enrolled.Liver and kidney function,HBVDNA,HBVM,AFP,US or CT scan of liver were tested every 1-3 month.The treatment efficacy was evaluated at month 12.RESULTS By month 12,the HBV DNA negative rates in LAM combined with ADV de novo group(45 cases) and ETV monotherapy group(30 cases) were 51.1% and 60.0% respectively.There was no significant difference(P>0.05).The HBeAg negative rates in LAM+ADV group and ETV group wre 30.4% and 26.7% respectively.There was no significant difference(P>0.05).The ALT normalization rates in two groups were similar.Viral breakthrough happened in 2 cases(4.4%) by month 12 in LAM+ADV group,and no viral resistance was observed,while viral breakthrough happened in 1 case(3.3%) by month 12 in ETV group.Improvement of liver function was obvious in both groups,for CTP and MELD scores decreased distinctly.The accumulative total mortality or liver transplantation rates were 9.4% and 8.7% respectively in LAM+ADV group and ETV group.No increase in blood creatinine above the upper normal limit was observed in both groups.CONCLUSION Both of LAM combined with ADV de novo and ETV monotherapy are best choice in treatment of patients with HBV-related decompensated cirrhosis.They can inhibit HBV replication obviously,improve liver function and decrease mortality.更多还原