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目的观察恩替卡韦和拉米夫定治疗Child-pugh B级乙型肝炎肝硬化的疗效及安全性。方法将65例乙型肝炎肝硬化患者随机分为恩替卡韦组和拉米夫定组。拉米夫定组30例,恩替卡韦组35例,以治疗24周为观察终点,分析两组疗效、病原学指标改变和不良反应。结果恩替卡韦组和拉米夫定组分别有48.6%和36.7%的患者由Child-pugh B级改善为Child-pugh A级,各组治疗前后比较差异有统计学意义(P<0.05);但治疗后两组之间Child-pugh评分比较差异无统计学意义(P>0.05)。恩替卡韦组和拉米夫定组患者血清HBV-DNA阴转率分别为74.3%和63.3%,各组治疗前后比较差异有统计学意义(P<0.05);两组HBeAg转换率(20.0%vs 15.0%)、ALT复常率(86.4%vs 80.0%)差异均无统计学意义(P均>0.05);两组治疗期间均未见严重不良反应。结论恩替卡韦比拉米夫定对Child-pugh B级乙型肝炎肝硬化患者有更好地治疗效果,且安全性高。
Objective To observe the efficacy and safety of entecavir and lamivudine in the treatment of Child-pugh class B hepatitis B cirrhosis. Methods 65 patients with hepatitis B cirrhosis were randomly divided into entecavir group and lamivudine group. 30 patients in lamivudine group and 35 patients in entecavir group were treated for 24 weeks. The curative effect, etiological changes and adverse reactions of the two groups were analyzed. Results The levels of Child-pugh B and Child-pugh B were improved in 48.6% and 36.7% of the entecavir and lamivudine groups, respectively, with significant difference before and after treatment (P <0.05) There was no significant difference in Child-pugh score between the two groups (P> 0.05). The seroconversion rates of HBV-DNA in patients with entecavir and lamivudine were 74.3% and 63.3%, respectively, and there was significant difference between before and after treatment in each group (P <0.05). The HBeAg conversion rate (20.0% vs 15.0 %), And the ALT normalization rate (86.4% vs 80.0%) had no significant difference (all P> 0.05). No adverse reactions were observed during the two groups. Conclusion Entecavir than lamivudine has better therapeutic effect on Child-pugh class B hepatitis B cirrhosis patients and is safe.