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目的:对乙型肝炎E抗原(HBeAg)阳性失代偿期乙肝肝硬化患者拉米夫定联合阿德福韦酯治疗后的临床资料进行回顾性分析。方法:对144例2015年1月至2016年5月入诊海丰县彭湃纪念医院进行治疗的HBeAg阳性失代偿期乙肝肝硬化患者既往病例资料进行回顾性分析,将72例进行拉米夫定初始治疗并产生耐药性后加用阿德福韦酯治疗的患者设为A组,将72例拉米夫定联合阿德福韦酯进行初始联合治疗的患者设为B组,对比两组患者治疗后HBeAg转阴率以及治疗后肝功能Child-Pugh分级评分情况。结果:B组患者HBeAg血清学转阴例数为19例,A组为5例,B组患者HBeAg血清学转阴率26.39%明显高于A组6.94%,差异较大,具有统计学意义(P<0.05)。B组患者12周末Child-Pugh分级评分与A组比较,差异无统计学意义(P>0.05),在治疗24周以及48周后,B组患者Child-Pugh分级评分情况均优于A组,差异具有统计学意义(P<0.05)。结论:拉米夫定联合阿德福韦酯对HBeAg阳性失代偿乙肝肝硬化患者使用,最佳时机为两种药物联合进行初始治疗,可较好提高患者HBeAg血清学转阴率,对改善肝功能、提高肝脏储备能力具有积极意义。
Objective: To retrospectively analyze the clinical data of lamivudine combined with adefovir dipivoxil in patients with hepatitis B E antigen (HBeAg) -positive decompensated hepatitis B cirrhosis. Methods: A retrospective analysis was performed on the data of 144 cases of HBeAg-positive decompensated hepatitis B cirrhosis who were treated in Pengfeng Memorial Hospital, Haifeng County from January 2015 to May 2016, and 72 cases were treated with lamivudine Patients initially treated with adefovir dipivoxil and subsequently treated with adefovir dipivoxil were enrolled as group A. 72 patients initially treated with lamivudine combined with adefovir dipivoxil were assigned to group B, HBeAg negative rate after treatment and Child-Pugh grading score of liver function after treatment. Results: In group B, HBeAg seronegative cases were 19 cases in group A and 5 cases in group A, HBeAg seroconvertion rate in group B was 26.39%, which was significantly higher than that in group A (6.94%), with significant difference P <0.05). The Child-Pugh grading score at 12th weekend in group B was not significantly different from that in group A (P> 0.05). After 24 weeks and 48 weeks, Child-Pugh grading score in group B was better than that in group A, The difference was statistically significant (P <0.05). Conclusion: Lamivudine combined with adefovir dipivoxil in patients with HBeAg-positive decompensated hepatitis B cirrhosis, the best time for the initial treatment of two drugs in combination can be better to improve the HBeAg seroconversion rate in patients with improvement Liver function, improve liver reserve capacity has a positive meaning.