林占洲,卢雪兰,刘彩霞
LIN Zhanzhou,LU Xuelan,LIU Caixia

• 1:惠州市中心人民医院肝病内科

摘要(Abstract)：

目的观察比较拉米夫定联合阿德福韦酯与恩替卡韦单药治疗乙型肝炎肝硬化3年的疗效。方法 34例乙型肝炎肝硬化患者使用拉米夫定联合阿德福韦酯治疗,另一组45例乙型肝炎肝硬化患者使用恩替卡韦治疗,进行基线情况及抗病毒3年的疗效及安全性比较分析。结果 2组患者的性别、年龄组成、Child-Pugh评分、基线HBV DNA水平、HBe Ag阳性比例均无统计学差异;治疗第1年、第2年、第3年结束时2组患者肝功Child-Pugh评分、肝硬化并发症发生率等均较治疗前好转且有统计学差异,但2组间比较无统计学差异;单药治疗组病毒转阴率、死亡率、失访率、肝细胞癌发生率均优于联合治疗组,但两者间无统计学差异,但联合治疗组有2名患者出现肌酐升高。结论拉米夫定联合阿德福韦或恩替卡韦单药治疗乙型肝炎肝硬化患者,均可获得较好疗效,但治疗3年2治疗组之间疗效无明显差异,在药物安全性方面恩替卡韦单药优于拉米夫定联合阿德福韦酯。
OBJECTIVE To investigate the clinical effects comparison of lamivudine combined with adefovir dipivoxil or entecavir alone on HBV-related hepatocirrhosis in 3 years. METHODS A total of 34 cases of patients with HBV-related hepatocirrhosis were treated by lamivudine combined with adefovir dipivoxil as combination group. 45 patients with HBV-related hepatocirrhosis were treated by entecavir as monotherapy group. The baseline data,clinical efficacy in 3 years and safety were compared between 2 groups.RESULTS There was no significant difference of gender ratio,age,Child-Pugh score,HBV DNA and HBe Ag positive rate between the 2 groups before treatment. After 1 year,2 years and 3 years of treatment the Child-Pugh score,complications rate were significantly improved in both groups. There was no significant difference of Child-Pugh score and complications between 2 groups after treatment.The negative conversion ratio,death ratio,defaulters ratio and incidence of hepatocellular carcinoma were significantly improved. There were 2 cases of patients shown a increase in creatinine. CONCLUSION Both of the therapies have great clinical effects on patients with HBV-related hepatocirrhosis. There is no significant difference of clinical effects after 3 years treatment between 2 groups. The safety of entecavir is proved to be better than the combination of lamivudine and adefovir dipivoxil.

关键词(KeyWords)： 拉米夫定;阿德福韦酯;恩替卡韦;乙型肝炎肝硬化
lamivudine;adefovir dipivoxil;entecavir;HBV-related hepatocirrhosis

Abstract:

Keywords:

基金项目(Foundation): 广东省药学会肝炎用药研究基金(2012G07)

作者(Author): 林占洲,卢雪兰,刘彩霞
LIN Zhanzhou,LU Xuelan,LIU Caixia

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