中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2011年
2期
84-87
,共4页
贾红宇%卢微%郑临%应灵军%杨益大
賈紅宇%盧微%鄭臨%應靈軍%楊益大
가홍우%로미%정림%응령군%양익대
肝炎,乙型,慢性%肝硬化,失代偿期%联合疗法%拉米夫定%阿德福韦酯
肝炎,乙型,慢性%肝硬化,失代償期%聯閤療法%拉米伕定%阿德福韋酯
간염,을형,만성%간경화,실대상기%연합요법%랍미부정%아덕복위지
Hepatitis B,chronic%Liver cirrhosis,decompensated%Combination therapy%Lamivudine%Adefovir dipivoxil
目的 比较拉米夫定与阿德福韦酯初始联合或拉米夫定单药治疗失代偿期乙型肝炎肝硬化患者2年的疗效.方法 60例失代偿期乙型肝炎肝硬化接受初始拉米夫定(LAM)与阿德福韦酯(ADV)联合抗病毒治疗,为初始联合组;55例接受拉米夫定(LAM)单药抗病毒治疗,为LAM单药组每1～3个月检测患者肝功能、肾功能、甲胎蛋白、乙型肝炎病毒标志物、血清HBV DNA、凝血酶原时间(PT)、肝脏的超声或CT检查,分别在治疗12个月和24个月时比较疗效.组间均数比较用Mann-Whitney检验,相关性分析时采用Pearson双侧t检验.结果 初始联合组45例治疗12个月时血清HBV DNA阴转率为51.1%(23/45),而40例LAM单药组HBV DNA阴转率为47.5%(19/40);至24个月时,初始联合组HBV DNA阴转率达86.7%(39/45),LAM单药组为60.0%(24/40),两组间差异有统计学意义(P＜0.05).初始联合组治疗24个月时,HBeAg血清学转换率为43.5%(10/23),LAM单药组HBeAg血清学转换率为30.0%(6/20),两组间差异有统计学意义(P＜0.05).ALT复常率在初始联合组治疗12个月时为71.1%(32/45),LAM单药组为65.0%(26/40),至24个月时两组ALT复常率分别为88.9%(40/45)和75.0%(30/40),差异有统计学意义(P＜0.05).初始联合组在治疗12个月和24个月时,分别有4.4%(2/45)和6.7%(3/45)发生病毒学突破,但均未检测到病毒学变异,LAM单药组在12个月和24个月时分别有22.5%(9/40)和37.5%(15/40)发生病毒学突破,并分别有17.5%(7/40)和32.5%(13/40)的患者中检测到病毒学变异,均较联合治疗组高(P＜0.05).初始联合治疗更能改善肝功能,Child-Turcotte-Pugh评分和终末期肝病模型评分亦有更明显下降.随访24个月,LAM和ADV初始联合治疗组累计死亡或肝移植率为16.7%,LAM单药组累计死亡或肝移植发生率为20.0%.两组均未发现有血清肌酐超过正常值上限的病例.结论 LAM与ADV初始联合治疗失代偿期乙型肝炎肝硬化患者能更明显抑制HBV复制,改善肝功能各项指标,降低病死率,值得临床应用.
目的 比較拉米伕定與阿德福韋酯初始聯閤或拉米伕定單藥治療失代償期乙型肝炎肝硬化患者2年的療效.方法 60例失代償期乙型肝炎肝硬化接受初始拉米伕定(LAM)與阿德福韋酯(ADV)聯閤抗病毒治療,為初始聯閤組;55例接受拉米伕定(LAM)單藥抗病毒治療,為LAM單藥組每1～3箇月檢測患者肝功能、腎功能、甲胎蛋白、乙型肝炎病毒標誌物、血清HBV DNA、凝血酶原時間(PT)、肝髒的超聲或CT檢查,分彆在治療12箇月和24箇月時比較療效.組間均數比較用Mann-Whitney檢驗,相關性分析時採用Pearson雙側t檢驗.結果 初始聯閤組45例治療12箇月時血清HBV DNA陰轉率為51.1%(23/45),而40例LAM單藥組HBV DNA陰轉率為47.5%(19/40);至24箇月時,初始聯閤組HBV DNA陰轉率達86.7%(39/45),LAM單藥組為60.0%(24/40),兩組間差異有統計學意義(P＜0.05).初始聯閤組治療24箇月時,HBeAg血清學轉換率為43.5%(10/23),LAM單藥組HBeAg血清學轉換率為30.0%(6/20),兩組間差異有統計學意義(P＜0.05).ALT複常率在初始聯閤組治療12箇月時為71.1%(32/45),LAM單藥組為65.0%(26/40),至24箇月時兩組ALT複常率分彆為88.9%(40/45)和75.0%(30/40),差異有統計學意義(P＜0.05).初始聯閤組在治療12箇月和24箇月時,分彆有4.4%(2/45)和6.7%(3/45)髮生病毒學突破,但均未檢測到病毒學變異,LAM單藥組在12箇月和24箇月時分彆有22.5%(9/40)和37.5%(15/40)髮生病毒學突破,併分彆有17.5%(7/40)和32.5%(13/40)的患者中檢測到病毒學變異,均較聯閤治療組高(P＜0.05).初始聯閤治療更能改善肝功能,Child-Turcotte-Pugh評分和終末期肝病模型評分亦有更明顯下降.隨訪24箇月,LAM和ADV初始聯閤治療組纍計死亡或肝移植率為16.7%,LAM單藥組纍計死亡或肝移植髮生率為20.0%.兩組均未髮現有血清肌酐超過正常值上限的病例.結論 LAM與ADV初始聯閤治療失代償期乙型肝炎肝硬化患者能更明顯抑製HBV複製,改善肝功能各項指標,降低病死率,值得臨床應用.
목적 비교랍미부정여아덕복위지초시연합혹랍미부정단약치료실대상기을형간염간경화환자2년적료효.방법 60례실대상기을형간염간경화접수초시랍미부정(LAM)여아덕복위지(ADV)연합항병독치료,위초시연합조;55례접수랍미부정(LAM)단약항병독치료,위LAM단약조매1～3개월검측환자간공능、신공능、갑태단백、을형간염병독표지물、혈청HBV DNA、응혈매원시간(PT)、간장적초성혹CT검사,분별재치료12개월화24개월시비교료효.조간균수비교용Mann-Whitney검험,상관성분석시채용Pearson쌍측t검험.결과 초시연합조45례치료12개월시혈청HBV DNA음전솔위51.1%(23/45),이40례LAM단약조HBV DNA음전솔위47.5%(19/40);지24개월시,초시연합조HBV DNA음전솔체86.7%(39/45),LAM단약조위60.0%(24/40),량조간차이유통계학의의(P＜0.05).초시연합조치료24개월시,HBeAg혈청학전환솔위43.5%(10/23),LAM단약조HBeAg혈청학전환솔위30.0%(6/20),량조간차이유통계학의의(P＜0.05).ALT복상솔재초시연합조치료12개월시위71.1%(32/45),LAM단약조위65.0%(26/40),지24개월시량조ALT복상솔분별위88.9%(40/45)화75.0%(30/40),차이유통계학의의(P＜0.05).초시연합조재치료12개월화24개월시,분별유4.4%(2/45)화6.7%(3/45)발생병독학돌파,단균미검측도병독학변이,LAM단약조재12개월화24개월시분별유22.5%(9/40)화37.5%(15/40)발생병독학돌파,병분별유17.5%(7/40)화32.5%(13/40)적환자중검측도병독학변이,균교연합치료조고(P＜0.05).초시연합치료경능개선간공능,Child-Turcotte-Pugh평분화종말기간병모형평분역유경명현하강.수방24개월,LAM화ADV초시연합치료조루계사망혹간이식솔위16.7%,LAM단약조루계사망혹간이식발생솔위20.0%.량조균미발현유혈청기항초과정상치상한적병례.결론 LAM여ADV초시연합치료실대상기을형간염간경화환자능경명현억제HBV복제,개선간공능각항지표,강저병사솔,치득림상응용.
Objective To compare the efficacy of Lamivudine (LAM) monotherapy and combination therapy with Adefovir Dipivoxil (ADV) for patients with hepatitis B virus (HBV) -related decompensated cirrhosis for 2 years.Methods A total of 115 patients with HBV-related decompensated cirrhosis were erolled in this study,among 60 patients were treated with LAM combined with ADV and 55 were treated with LAM.The liver and kidney functions,HBV DNA,HBV-M,AFP,Ultrasond or CT scan of liver were tested every l-3months.the treatment efficacy was evaluated by month 12 and 24.Results By month 12,the HBVDNA negative rates of combination therapy group and LAM monotherapy group were 51.1% (45 cases) and 47.5% (40 cases) respectively,by month 24 the rates were 86.7% and 60.0% respectively.By month 24 the HBeAg negative rates of combination therapy group and LAM monotherapy group were 43.5% and 30.0%respectively,with significant difference existed between the two therapy groups (P ＜ 0.05).By month 24,the ALT normalization rates of the two groups were 88.9% and 72.5% respectively.Viral breakthrough happened in 2 cases (4.4%) by month 12 and 3 cases (6.7%) by month 24 in LAM and ADV combination group,but no viral resistance observed.Viral breakthrough happened in 9 cases (22.5%) by month 12 and 15 cases (37.5%)by month 24 in LAM monotherapy group with viral resistance observed in 7 cases (17.5%) by month 12 and 13 cases (32.5) by month 24.Significant difference existed between the two groups (P ＜ 0.05).Improvement of liver function was more obviously in the combination group.The accumulative total mortality or liver transplantation rate were 16.7% and 20.0% respectively in combination therapy group and LAM monotheapy group.No renal dysfunction observed in both groups.Conclusion LAM combined with ADV is better choice for patients with HBV-related decompensated cirrhosis as compared to LAM monotherapy.
