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目的探究拉米夫定联合阿德福韦酯治疗HBeAg阳性失代偿期乙肝肝硬化患者的恰当时机。方法回顾性分析杭州师范大学附属医院于2014年1月—2015年1月收治的HBeAg阳性失代偿期乙肝肝硬化患者100例,将给予拉米夫定初始治疗耐药后加用阿德福韦酯挽救治疗的50名患者作为对照组,同时选取给予拉米夫定加阿德福韦酯初始联合治疗的患者50例作为观察组,比较分析2组治疗的临床疗效。结果观察组治疗后谷丙转氨酶(ALT)、总胆红素(TBIL)、Child-Pugh评分和HBV-DNA分别为(62.74±9.88)U/L、(43.27±6.52)μmol/L、(8.27±0.91)分和(0.78±0.19)×103拷贝/ml,低于对照组治疗后,2组治疗后均低于治疗前,观察组治疗后ALB为(39.36±4.49)g/L,高于治疗前及对照组治疗后,差异均具有统计学意义(P<0.05)。2组治疗后ChildPugh分级结果经秩和检验比较,差异有统计学意义(P<0.05);观察组治疗后HBV-DNA和HBeAg阴转率结果分别为64.0%(32/50)和54.0%(27/50),均高于对照组,差异有统计学意义(P<0.05)。结论采用初始联合拉米夫定和阿德福韦酯治疗HBeAg阳性失代偿期乙肝肝硬化患者临床效果显著,HBeAg血清学转阴率高,且ChildPugh分级评分分数降低,改善肝脏储备功能,血清中HBV-DNA载量降低,临床上值得进一步推广应用。
Objective To investigate the appropriate timing of lamivudine combined with adefovir dipivoxil in patients with HBeAg-positive decompensated cirrhosis. Methods A retrospective analysis of 100 cases of hepatitis B cirrhosis patients with HBeAg-positive decompensated cirrhosis admitted from January 2014 to January 2015 in the Affiliated Hospital of Hangzhou Normal University would be given initial treatment with lamivudine plus adefovir 50 patients treated with etoposide as control group were selected as the observation group and 50 patients as the initial combination therapy with lamivudine plus adefovir dipivoxil as the observation group. The clinical efficacy of the two groups were compared. Results The levels of ALT, TBIL, Child-Pugh and HBV-DNA in the observation group were (62.74 ± 9.88) U / L, (43.27 ± 6.52) μmol / L and ± 0.91) and (0.78 ± 0.19) × 103 copies / ml, respectively, which was lower than that of the control group after treatment, but the ALB in the observation group was (39.36 ± 4.49) g / L after treatment Before treatment and control group after treatment, the differences were statistically significant (P <0.05). The results of ChildPugh grading after two groups were statistically significant (P <0.05) by rank sum test (P <0.05). The negative conversion rates of HBV DNA and HBeAg in the observation group were 64.0% (32/50) and 54.0% 27/50), both higher than the control group, the difference was statistically significant (P <0.05). Conclusions The initial combination of lamivudine and adefovir dipivoxil has a significant clinical effect in patients with HBeAg-positive decompensated cirrhosis of the liver. HBeAg seroconversion rates are high, ChildPugh classification score scores are decreased, liver reserve function, serum HBV-DNA load in the lower, clinically worth further promotion and application.