CAJ | 학술논문

目的比较拉米夫定与阿德福韦酯初始联合与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28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;26例接受拉米夫定(LAM)单药抗病毒治疗,为LAM单药组.两组均给予保肝对症支持治疗.疗程24个月.观察治疗前后不同时间点患者的病毒学、生化学、血清学等变化情况.结果初始联合组患者治疗后12月和24月HBV DNA阴转率(85.7%、92.9%)与拉米夫定单药组(61.5%,65.4%)比较,差异有统计学意义(P<0.05).在24个月时初始联合组患者HBeAg血清学转换率(64.3%)与拉米夫定单药组(34.6%)比较,差异有统计学意义(P<0.05).两组患者ALT复常率在治疗各个时间点比较差异无统计学意义(P>0.05).两组患者生化指标同期比较差异无统计学意义(P>0.05).初始联合组观察期间未检测到病毒学变异,LAM单药组在12月和24月时分别有11.5%(3/26)和23.1%(6/26)的患者中检测到病毒学变异.两组均未发现有血清肌酐超过正常值上限的病例.结论拉米夫定与阿德福韦酯初始联合治疗失代偿期乙型肝炎肝硬化患者在病毒学、血清学应答和HBV耐药变异等方面均优于拉米夫定单药治疗,且肾脏安全性良好,值得临床应用.
목적비교랍미부정여아덕복위지초시연합여랍미부정단약치료실대상기을형간염간경화환자2년적료효.방법28례실대상기을형간염간경화접수초시랍미부정(LAM)여아덕복위지(ADV)연합항병독치료,위초시연합조;26례접수랍미부정(LAM)단약항병독치료,위LAM단약조.량조균급여보간대증지지치료.료정24개월.관찰치료전후불동시간점환자적병독학、생화학、혈청학등변화정황.결과초시연합조환자치료후12월화24월HBV DNA음전솔(85.7%、92.9%)여랍미부정단약조(61.5%,65.4%)비교,차이유통계학의의(P<0.05).재24개월시초시연합조환자HBeAg혈청학전환솔(64.3%)여랍미부정단약조(34.6%)비교,차이유통계학의의(P<0.05).량조환자ALT복상솔재치료각개시간점비교차이무통계학의의(P>0.05).량조환자생화지표동기비교차이무통계학의의(P>0.05).초시연합조관찰기간미검측도병독학변이,LAM단약조재12월화24월시분별유11.5%(3/26)화23.1%(6/26)적환자중검측도병독학변이.량조균미발현유혈청기항초과정상치상한적병례.결론랍미부정여아덕복위지초시연합치료실대상기을형간염간경화환자재병독학、혈청학응답화HBV내약변이등방면균우우랍미부정단약치료,차신장안전성량호,치득림상응용.
Objective To evaluate the efficacy of denovo combination therapy with lamivudine(LAM) and adefovir dipivoxil(ADV) in the treatment of patients with decompensated cirrhosis related to HBV. Methods 28 patients with decompensated cirrhosis related to HBV were given LAM combined with ADV(the denovo combination group); 26 cases were only given LAM(monotherapy of LAM). Basic approaches including liver protection, symptom-driven intervention, and supporting therapy, were given to all of the individuals. A course of two-year was applied to all. Virology, biochemistry and serology changes were observed pro-and post-treatment in different time point. Results The undetectable rates of HBVDNA at month 12, 24 were 85.7%, 92.9%, respectivly for the denovo combination group, and(61.5%, 65.4%) for the monotherapy of LAM group(P<0.05). After 24 months treatment, the rates of HBeAg seroconversion were 64.3% for the denovo combination group, and 34.6% for the LAM group(P<0.05). The recover rate of ALT of two groups in different time point has no significant difference P>0.05). Biochemical index in the same period of the two groups has no significant difference(P>0.05). Virological mutation occurred to none in denovo combination group, and 11.5%(3/26) and 23.1%(6/26) respectively at 12 and 24 months in LAM group. Elevated level of sCr didn't arised at the end of treatment in two groups. Conclusion Present study reveals that denovo combination therapy of LAM and ADV is superior to monotherapy of LAM in virological, serological response and HBV drug resistance mutation, also the renal safety is favorable, is worthy of clinical application.