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1、乙型肝炎肝硬化失代偿期抗病毒治疗疗效观察作者:冯静 都烽 苏杰 李萍 伦秀英 【摘要】目的观察核苷类药物治疗乙型肝炎肝硬化失代偿期的疗效。方法对96例乙型肝炎肝硬化失代偿期患者随机分组,所有患者在保肝对症治疗的基础上,分别给予拉米夫定(A组)100mg/d、阿德福韦酯(B组)10mg/d、恩替卡韦(C组)0.5mg/d口服,疗程为48周,同时设立保守治疗组(D组),观察所有患者临床症状、体征、肝功能变化、凝血酶原时间活动度(PTA)、HBV-DNA定量、HBeAg阴转、HBeAg/HBeAb转换情况。结果通过抗病毒治疗,A、B、C
2、三组患者无一例死亡,临床表现、体征、肝功能、PTA均有明显改善,HBeAg血清转换率三组分别为20%、8%、23%,三者统计学处理有显著差异(P<0.05),HBV-DNA阴转率三组分别为48%、28%、68.2%,组间比较有显著差异(P<0.05)。D组疗效最差,死亡3例,抗病毒治疗组与保守治疗组疗效有显著差异(P<0.01)。结论乙型肝炎肝硬化失代偿期患者应行抗病毒治疗,可首先选用拉米夫定或恩替卡韦,为防止应用拉米夫定病毒变异,可在病情好转后改用阿德福韦酯继续治疗。 【关键词】肝硬化;失代偿;抗病毒治疗 【Abstra
3、ct】ObjectiveToinvestigatetheclinicaltherapeuticeffectofNucleosidedrugsondecompensatedcirrhosispatientsfollowingchronichepatitisB.Methods968decompensatedcirrhosispatientswererandomlydividedintofourgroups,allthegroupsweregivenconventionaltreatmentwhilethegroupAweregivenl
4、amivudine100mg/day,groupBweregivenadefovir10mg/day,groupCweregivenentecavir0.5mg/day,withtreatmentfor48weeks.Thecontrolgroupweregivenconservativetreatmentonly.Thentoobservetheclinicalsymptoms,bodysignsofallthepatients,thechangesoftheliverfunctions,Prothrombintimeactivi
5、ty(PTA),HBVDNAlevelandHBeAgnegative,HBeAg/HBeAbconversionsituation.ResultsAfterNucleosideantiviraltreatmentsfor48weeks,nopatientsdiedinthestudygroups.Decompensatedcirrhosispatientsweresignificantlyimprovedinclinicalsymptoms,bodysigns,liverfunctions,PTA,withdecreasedHBV
6、DNAlevel(P<0.05);theratesofHBeAgnegativeinthesethreegroupswere20%,8%and23%,therewassignificantdifferencesforthesethreegroups(PA/B<0.05,PC/B<0.05,PA/C<0.05),theratesofHBV-DNAnegativeforthesethreegroupsware48%,28%and68.2%,differencesofthethreegroupswerealsosignificant(PA
7、/B<0.05,PC/B<0.05,PA/C<0.05),thetherapeuticefficacywasworstforthecontrolgroup,3casesdied,therewasanobvioustherapeuticefficacydifferencebetweenanti-virustreatmentgroupsandcontrolgroup(P<0.01)。Conclusion8DecompensatedlivercirrhosispatientsofHepatitisBshouldreceiveantiret
8、roviraltreatment.LamivudineandEntecavircanbechosenfirstforthetreatment.InordertopreventtheviralmutationinducedbyLamiv