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目的探讨拉米夫定联合阿德福韦酯与恩替卡韦单药治疗失代偿期乙型肝硬化患者的临床疗效。方法选取厦门市第五医院2014年1月—2015年6月收治的失代偿期乙型肝硬化患者88例,按照随机数字表法分为对照组和观察组,各44例。患者入院后均给予保肝对症支持治疗,对照组患者给予恩替卡韦口服治疗,观察组患者给予拉米夫定联合阿德福韦酯口服治疗,两组患者均持续治疗48周。比较两组患者治疗前及治疗48周后血清总胆红素(TBi L)、清蛋白(ALB)、丙氨酸氨基转移酶(ALT)、凝血酶原活动度(PTA)及Child-Pugh评分,并于治疗后4、12、24、48周检测比较两组患者的HBV-DNA表达,记录比较两组患者不良反应发生情况。结果治疗前及治疗48周后,两组患者血清ALT、TBi L、PTA、ALB水平及Child-Pugh评分比较,差异无统计学意义(P>0.05);治疗48周后,两组患者ALT、Child-Pugh评分、TBi L低于治疗前,PTA、ALB水平高于治疗前(P<0.05)。治疗4、12、24、48周,两组患者HBV-DNA转阴率比较,差异无统计学意义(P>0.05)。两组患者均未出现严重肾功能损伤等不良反应。结论采用拉米夫定联合阿德福韦酯与恩替卡韦单药治疗失代偿期乙型肝硬化患者疗效相当,均可有效改善肝功能,提高HBV-DNA转阴率,且安全性较高。
Objective To investigate the clinical efficacy of lamivudine combined with adefovir dipivoxil and entecavir monotherapy in decompensated patients with cirrhosis of the liver. Methods Eighty-eight patients with decompensated cirrhosis who were admitted to Xiamen Fifth Hospital from January 2014 to June 2015 were divided into control group and observation group according to the random number table method, with 44 cases in each group. All patients were given hepatoprotective symptomatic supportive therapy after admission. Patients in the control group were treated with entecavir orally, while patients in the observation group were treated with lamivudine plus adefovir dipivoxil. Both groups were treated for 48 weeks. The levels of total bilirubin (TBiL), albumin (ALB), alanine aminotransferase (ALT), prothrombin activity (PTA) and Child-Pugh score before treatment and after 48 weeks of treatment were compared between the two groups , And the HBV-DNA expression was compared between the two groups at 4, 12, 24, and 48 weeks after treatment. The incidence of adverse reactions was recorded and compared between the two groups. Results After treatment for 48 weeks, there was no significant difference in serum ALT, TBiL, PTA and ALB levels and Child-Pugh scores between the two groups (P> 0.05). After 48 weeks of treatment, ALT, Child-Pugh score, TBi L before treatment, PTA, ALB levels were higher than before treatment (P <0.05). After treatment for 4, 12, 24 and 48 weeks, there was no significant difference in HBV-DNA negative rates between the two groups (P> 0.05). Two groups of patients did not appear serious renal dysfunction and other adverse reactions. Conclusions The combination of lamivudine and adefovir dipivoxil and entecavir monotherapy in patients with decompensated cirrhosis of the liver has the same curative effect, which can effectively improve liver function, increase the negative rate of HBV-DNA, and have higher safety.