CAJ | 학술논문

目的：探讨单药拉米夫定、单药恩替卡韦及替比夫定联合阿德福韦对失代偿期乙型肝炎肝硬化患者的长期疗效。方法选取2008年1月—2010年1月就诊于首都医科大学附属北京佑安医院的失代偿期乙型肝炎肝硬化应用单药拉米夫定、单药恩替卡韦及替比夫定联合阿德福韦抗病毒药物初治患者85例，持续抗病毒治疗12个月以上，随访3年。记录患者Child评分变化、是否发生耐药及是否死亡。结果（1）随访结束时肝功能改善情况：拉米夫定组好转17例，稳定2例，恶化16例；恩替卡韦组好转20例，稳定5例，恶化6例；替比夫定联合阿德福韦组好转15例，稳定1例，恶化3例。3组的肝功能恢复情况间差异有统计学意义（H=22.100，P=0.000）；两两比较显示，拉米夫定组与恩替卡韦组、替比夫定联合阿德福韦组间差异有统计学意义（ P值分别为0.017、0.000）。（2）随访结束时耐药情况：拉米夫定组的耐药率为31.4%（11/35），恩替卡韦组的耐药率为3.2%（1/31），替比夫定联合阿德福韦组的耐药率为10.5%（2/19）。3组患者的耐药率间差异有统计学意义（χ2=10.133，P=0.013）；两两比较显示，拉米夫定组与恩替卡韦组、替比夫定联合阿德福韦组间差异有统计学意义（ P值分别为0.003、0.016）。（3）随访结束时死亡率：拉米夫定组的死亡率为22.9%（8/35），恩替卡韦组的死亡率为16.1%（5/31），替比夫定联合阿德福韦组的死亡率为5.3%（1/19），3组患者死亡率比较差异无统计学意义（χ2=2.770，P=0.250）。结论抗病毒长期治疗失代偿期乙型肝炎肝硬化可显著改善患者肝功能。初始治疗恩替卡韦单药与替比夫定联合阿德福韦治疗疗效相当，优于拉米夫定单药治疗，替比夫定联合阿德福韦初始治疗长期病死率可能更低。
목적：탐토단약랍미부정、단약은체잡위급체비부정연합아덕복위대실대상기을형간염간경화환자적장기료효。방법선취2008년1월—2010년1월취진우수도의과대학부속북경우안의원적실대상기을형간염간경화응용단약랍미부정、단약은체잡위급체비부정연합아덕복위항병독약물초치환자85례，지속항병독치료12개월이상，수방3년。기록환자Child평분변화、시부발생내약급시부사망。결과（1）수방결속시간공능개선정황：랍미부정조호전17례，은정2례，악화16례；은체잡위조호전20례，은정5례，악화6례；체비부정연합아덕복위조호전15례，은정1례，악화3례。3조적간공능회복정황간차이유통계학의의（H=22.100，P=0.000）；량량비교현시，랍미부정조여은체잡위조、체비부정연합아덕복위조간차이유통계학의의（ P치분별위0.017、0.000）。（2）수방결속시내약정황：랍미부정조적내약솔위31.4%（11/35），은체잡위조적내약솔위3.2%（1/31），체비부정연합아덕복위조적내약솔위10.5%（2/19）。3조환자적내약솔간차이유통계학의의（χ2=10.133，P=0.013）；량량비교현시，랍미부정조여은체잡위조、체비부정연합아덕복위조간차이유통계학의의（ P치분별위0.003、0.016）。（3）수방결속시사망솔：랍미부정조적사망솔위22.9%（8/35），은체잡위조적사망솔위16.1%（5/31），체비부정연합아덕복위조적사망솔위5.3%（1/19），3조환자사망솔비교차이무통계학의의（χ2=2.770，P=0.250）。결론항병독장기치료실대상기을형간염간경화가현저개선환자간공능。초시치료은체잡위단약여체비부정연합아덕복위치료료효상당，우우랍미부정단약치료，체비부정연합아덕복위초시치료장기병사솔가능경저。
Objective To evaluate the long-term effects of decompensated cirrhosis patients treated by lamivudine or entecavir or telbivudine combined adefovir. Methods 85 patients with hepatitis B-induced decompensated liver cirrhosis visiting Beijing Youan hospital from January 2008 to January 2010 were chosen as the research subjects,who received continuous treat-ment of lamivudine or entecavir or telbivudine combined with adefovir for more than 12 months and were followed up for 3 years. The score changes of Child-Pugh,drug resistance or not,death or survival were recorded. Results (1) After 3 year's follow-up,the improvement of liver function:in lamivudine group 17 cases improved,2 cases steady,16 cases worsened;in ente-cavir group 20 cases improved,5 cases steady,6 cases worsened;in telbivudine combined adefovir group 15 cases improved,1 cases steady;3 cases worsened;the difference of the improvement in liver function among the three groups was statistical signifi-cant(H=22. 100,P=0. 000). After comparing the improvement between two groups,it showed that the differences between lamivudine group and entecavir group and telbivudine combined adefovir group were significant( P=0. 017 and 0. 000 respective-ly). (2) In terms of drug resistance:the incidence of drug resistance was 31. 4%(11/35) in lamivudine group,3. 2%(1/31)in entecavir group and 10. 5%(2/19)in telbivudine combined adefovir group and the difference among the three groups was significant(χ2 =10. 133,P=0. 013). Comparison between two groups showed that the differences between lamivu-dine group and entecavir group as well as telbivudine combined adefovir group were significant( P=0. 003,0. 016 respective-ly). (3)After follow-up,the incidence of death was 22. 9%(8/35) in lamivudine group,was 16. 1%(5/31) in ente-cavir group and 5. 3%(1/19) in telbivudine combined adefovir group,and the difference among the three groups was not sig-nificant(χ2 =2. 770,P=0. 250). Conclusion Long term antiviral treatment in patients with decompensated liver cirrhosis can significantly improve liver function. The efficacy of initial treatment with entecavir equals to that of initial treatment with telbi-vudine combined adefovir,but prior to that of initial treatment with lamivudine. Initial treatment with telbivudine combined adefo-vir probably causes low mortality in long term.