拉米夫定治疗失代偿期乙肝肝硬化的临床研究

目的探讨失代偿期乙肝肝硬化患者应用拉米夫定(LVD)治疗的临床效果及对病程进展的影响。方法108例失代偿期乙肝肝硬化患者随机分成治疗组(58例)和对照组(50例)。治疗组服用LVD 100 mg/d,同时给予常规综合治疗。对照组仅给予常规综合治疗,随访时间为(28±3)个月。结果治疗组和对照组死亡率分别为6.9%和14.0%(P<0.05),Child Pugh评分下降≥2分的患者分别为89.2%和62.4%(P<0.05)。肝癌发生率分别为3.4%和4.0%(P>0.05)。治疗组在降低血清胆红素和转氨酶、升高血清白蛋白水平、降低Child Pugh评分、改善肝功能方面均明显优于对照组。治疗后HBeAg和HBV-DNA转阴率以及HBeAg血清转换率明显高于对照组(P<0.05)。治疗组在12、24个月时发生YMDD变异率为24.1%和35.2%,但多数发生变异的患者继续治疗肝功能保持相对稳定。结论对失代偿期肝硬化患者应用LVD治疗可以快速抑制乙肝病毒复制,改善肝功能,延缓病情进展。

A clinical study on lamivudine treatment for decompensated cirrhosis due to hepatitis B

Objective To explore the clinical effect of Lamivudine(LVD) on patients with decompensated cirrhosis due to hepatitis B and on the course of disease development.Methods A total of 108 patients with decompensated cirrhosis due to hepatitis B were enrolled and randomly divided into the treatment group(58 cases) and the control group(50 cases).Patients in the treatment group received routine colligative treatment and LVD 100mg daily,while patients in the control group received routine colligative treatment only.All the patients were followed up for(28±3) months.Results The mortality rate was 6.9% vs.14.0% in the treatment and control groups(P<0.05).The patients whose Child-Pugh score decreased by more than 2 were 89.2% vs.62.4%((P<0.05)).The rate of developing hepatocellular carcinoma was 3.4% vs.4.0%(P>0.05).After treatment the serum ALT and TBIL levels dropped,the serum albumin level increased,and the Child-Pugh score decreased.The improvement of liver function in the treatment group was better than that in the control group.The HBeAg and HBV-DNA negative rate and HBeAg seroconversion rate in the treatment group were higher than those in the control group(P<0.05).The rate of YMDD mutations was 24.1% and 35.2% in the treatment group at the end of 12 and 24 months,but the relative stability liver function remained the same in most YMDD mutation patients.Conclusion LVD can inhibit virus replication rapidly and improve liver function,prevent exacerbation in patients with decompensated(cirrhosis.)