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目的比较核苷(酸)单药与联合治疗对失代偿期乙型肝炎肝硬化患者的疗效。方法回顾性分析130例核苷(酸)单药或联合治疗失代偿期乙型肝炎肝硬化患者的临床资料。单药组111例,其中恩替卡韦组(ETV)25例,阿德福韦酯组(ADV)45例,拉米夫定组(LAM)41例;联合组[替比夫定(LDT)+ADV]19例。于治疗后4、12、24、48周观察患者丙氨酸氨基转移酶(ALT)水平、Child评分、HBVDNA变化,48周累积肝癌发生率、耐药发生率、乙肝病毒e抗原(HBeAg)阴转率及平均住院次数等。结果 4周时各组患者ALT水平较基线水平显著下降(P<0.05)。ETV组、LDT+ADV组12周,LAM组24周,ADV组48周时HBVDNA水平较基线明显降低(P<0.05);LDT+ADV组4周时HBVDNA阴转率显著高于单药组(P<0.05)。LDT+ADV组24周、各单药组48周时Child评分较基线明显下降(P<0.05)。LDT+ADV组48周HBeAg阴转率(15.8%)高于LAM组(4.9%)及ADV组(4.4%),P<0.05。48周LAM、ADV组累积耐药率分别为24.4%、6.7%,ETV组及LDT+ADV组无耐药发生。结论失代偿期乙型肝炎肝硬化患者,LDT联合ADV治疗抑制病毒快、耐药率低,可成为失代偿期乙型肝炎肝硬化患者优化的抗病毒治疗方案之一。
Objective To compare the efficacy of nucleoside (acid) monotherapy and combination therapy in patients with decompensated hepatitis B cirrhosis. Methods A retrospective analysis of 130 cases of nucleoside (acid) monotherapy or combined treatment of decompensated hepatitis B cirrhosis in patients with clinical data. 111 patients in the monotherapy group, including 25 entecavir (ETV), 45 adefovir dipivoxil (ADV) and 41 lamivudine (LAM). The combination group [telbivudine (LDT) ] 19 cases. At 4, 12, 24 and 48 weeks after treatment, the levels of alanine aminotransferase (ALT), Child score, HBVDNA changes, the cumulative incidence of hepatocellular carcinoma 48 weeks, the incidence of drug resistance, HBeAg Transfer rate and average number of hospitalizations. Results At 4 weeks, ALT levels in all groups were significantly lower than those in baseline (P <0.05). The levels of HBVDNA in ETV group, LDT + ADV group at 12 weeks, LAM group at 24 weeks and ADV group at 48 weeks were significantly lower than those at baseline (P <0.05) P <0.05). The score of Child in LDT + ADV group was significantly lower than that of baseline at 24 weeks (P <0.05). In the LDT + ADV group, the HBeAg negative rate (15.8%) in 48 weeks was higher than that in LAM group (4.9%) and ADV group (4.4%), and the cumulative drug resistance rates were 24.4% %, ETV group and LDT + ADV group no drug resistance. Conclusions In patients with decompensated hepatitis B cirrhosis, LDT combined with ADV treatment can inhibit the virus quickly and the drug resistance rate is low, which may be one of the optimized antiviral treatment regimens for patients with decompensated hepatitis B cirrhosis.