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目的观察初始拉米夫定(LAM)联合阿德福韦酯(ADV)对e抗原阴性乙型肝炎失代偿期肝硬化的治疗效果。方法选择2011年1月—2013年1月南阳市中心医院感染科收治的e抗原阴性乙型肝炎失代偿期肝硬化患者共200例,随机分为联合治疗组(LAM+ADV组)80例、单药治疗组共120例:其中拉米夫定单药组(LAM组)60例、阿德福韦酯单药组(ADV组)60例。抗乙肝病毒药物按照常规剂量口服(LAM100 mg/d、ADV10 mg/d)。各组的保肝治疗方案相同。比较各组患者在治疗前及治疗后12,24,48周血清HBV DNA水平;治疗前及治疗后2,4,6,8周肝功能转归以及Child-Pugh评估。结果 LAM+ADV组与LAM组和ADV组比较:在治疗48周时HBV DNA阴转率分别为97.5%、83.3%和80%,联合治疗组与各单药组差异均有统计学意义(P<0.05);在治疗8周时Child-Pugh计分分别为6.8±1.0、7.1±1.3和7.3±1.2,联合治疗组与各单药组差异均有统计学意义(P<0.05);肝功能恢复速度LAM+ADV组较LAM组和ADV组快,(LAM+ADV组6周,LAM组和ADV组均8周)。在治疗8周时肝功能无差异。结论对e抗原阴性乙型肝炎失代偿期肝硬化,初始拉米夫定联合阿德福韦酯的治疗效果优于单用拉米夫定或阿德福韦酯治疗效果。
Objective To observe the therapeutic effect of initial lamivudine (LAM) combined with adefovir dipivoxil (ADV) on e antigen negative decompensated cirrhosis of hepatitis B patients. Methods A total of 200 patients with e antigen negative hepatitis B decompensated cirrhosis who were admitted to Nanyang Central Hospital Department of Infectious Diseases between January 2011 and January 2013 were randomly divided into combined treatment group (LAM + ADV group), 80 cases There were 120 cases in monotherapy group: 60 cases in lamivudine monotherapy group (LAM group) and 60 cases in adefovir dipivoxil monotherapy group (ADV group). Anti-HBV drugs were administered orally at regular doses (LAM 100 mg / d, ADV 10 mg / d). Each group of liver protection programs the same. The levels of serum HBV DNA before treatment and 12, 24, and 48 weeks after treatment were compared between groups. Liver function was assessed before and 2, 4, 6, and 8 weeks after treatment and Child-Pugh evaluation. Results Compared with LAM group and ADV group, the negative rate of HBV DNA in the LAM + ADV group was 97.5%, 83.3% and 80% respectively at 48 weeks of treatment, and there was significant difference between the combination therapy group and each single drug group (P <0.05). Child-Pugh scores at the 8th week were 6.8 ± 1.0, 7.1 ± 1.3 and 7.3 ± 1.2, respectively. There was significant difference between the combination therapy group and each single drug group (P <0.05); liver function The recovery rate of LAM + ADV group was faster than that of LAM group and ADV group (6 weeks in LAM + ADV group and 8 weeks in LAM group and ADV group). There was no difference in liver function at 8 weeks of treatment. Conclusions The efficacy of initial lamivudine combined with adefovir dipivoxil is better than that of lamivudine alone or adefovir dipivoxil for e antigen negative hepatitis B decompensated cirrhosis.