【作者】 邱源旺； 黄利华； 周红燕； 俞萍； 吴杭源； 李燚光； 汤勤；

【Author】 QIU Yuan-wang,HUANG Li-hua,ZHOU Hong-yan,YU Ping,ZHOU Hong-yan,WU Huang-yuan,LI Yi-guang,TANG Qin.Wuxi Infectious Disease Hospital,Wuxi 214000,China

【机构】 Wuxi Infectious Disease Hospital；

【摘要】 目的探讨乙型肝炎肝硬化失代偿期患者抗病毒治疗的疗效及安全性.方法2006年6月至2008年5月在门诊和住院乙型肝炎肝硬化失代偿期患者124例,随机分为4组,A组单用拉米夫定100mg/d;B组采用阿德福韦酯10mg/d;C组采用阿德福韦酯10mg/d、拉米夫定100mg/d联合治疗;D组采用恩替卡韦0.5mg/d治疗;4组均治疗104周。结果治疗104周时4组患者间ALT水平、HBeAg阳性患者血清转换率比较,差异均无统计学意义。C组、D组患者HBV DNA达到检测水平以下的百分率与A、B患者比较,差异有统计学意义(χ~2=9.934,P<0.05)。治疗104周4组间Child-Pugh评分比较差异无统计学意义。4组患者的基因型耐药率分别为28.1%(9/32)、6.5%(2/31)、0、0(χ~2=20.837,P<0.001),A组9例耐药患者测序为rtM204V+rtL180M变异6例,rtM204I+rtL180M变异2例,rtM204I变异1例。B组2例耐药患者测序为rtA181V和rtN236T变异各1例。B组、C组分别有3、5例患者出现血肌酐升高。结论采用ETV和LAM联合ADV治疗乙型肝炎肝硬化失代偿期可取得更好疗效。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of antiviral therapy in the patients with decompensated cirrhosis due to chronic hepatitis B.Methods A total of 124 patients were randomly assigned into four groups.In A group,patients received lamivudine for 104 weeks.In group B,patients received adefovir dipivoxil for 104 weeks.In group C,patients received lamivudine in combination with adefovir dipivoxil for 104 weeks.In group D,patients received Entecavir for 104 weeks Results There were no significant difference in the level of ALT and the rate of HBeAg seroconversion among four groups after 104-week treatment(P> 0.05). At week 104,there was significant difference in the undetectable HBV DNA rate between group C and group B,group C and group A;and the same result between group D and group B,group D and group A.and there was no significant difference in the Child-Pugh score among four groups, and the rate of drug resistant genotype was28.1%(9/32)、6.5%(2/31)、0、0.Six patients had rtM204V+rtL180M,two patients had rtM204I+rtL180M and one patient had rtM204I mutation in group A.One patient had rtA181V and another one had rtN236T mutation in group B.Conclusion Entecavir and lamivudine in combination with Adefovir dipivoxil are effective therapy for decompensated cirrhosis due to chronic hepatitis B.更多还原