CAJ | 학술논문

目的：比较阿德福韦酯（ ADV）与恩替卡韦（ ETV）治疗低病毒载量代偿期乙肝肝硬化患者的疗效。方法2011年1月—2012年6月选取低病毒载量代偿期乙肝肝硬化（ HBV DNA均＜2ˇ．0×104拷贝／ml ）患者96例，按照随机数字表分为2组，其中48例接受阿德福韦酯抗病毒治疗（ ADV组），48例接受恩替卡韦抗病毒治疗（ ETV组），每1～3个月检测患者肝功能[丙氨酸氨基转移酶（ALT）、总胆红素（TB）、白蛋白（Alb）]、肾功能、甲胎蛋白、乙肝三系、血清HBV DNA、凝血酶原时间（ PT）、肝脏B型超声或CT检查，随访12个月比较疗效及不良反应和病死率。结果 ADV组和ETV组12个月后血清HBV DNA 阴转率均为100％，比较差异无统计学意义（ P ＞0．05）；ADV组治疗12个月HBeAg血清转换率及病毒学突破率为16．7％、2．1％，ETV组分别为14．6％、4．2％，差异比较均无统计学意义（ P ＞0．05）；治疗12个月后，2组ALT、TB、Alb、PT均较治疗前显著改善（ P ＜0．05），但2组间比较差异均无统计学意义（ P ＞0．05）；2组均未发现有血清肌酐（SCr）和乳酸（LA）超过正常值上限的病例。 ADV组死亡1例（2．1％）， ETV组无死亡病例。结论阿德福韦酯或恩替卡韦治疗低病毒载量代偿期乙肝肝硬化患者均能明显抑制HBV DNA复制，改善肝功能各项指标，降低失代偿的发生，值得临床应用。
목적：비교아덕복위지（ ADV）여은체잡위（ ETV）치료저병독재량대상기을간간경화환자적료효。방법2011년1월—2012년6월선취저병독재량대상기을간간경화（ HBV DNA균＜2ˇ．0×104고패／ml ）환자96례，안조수궤수자표분위2조，기중48례접수아덕복위지항병독치료（ ADV조），48례접수은체잡위항병독치료（ ETV조），매1～3개월검측환자간공능[병안산안기전이매（ALT）、총담홍소（TB）、백단백（Alb）]、신공능、갑태단백、을간삼계、혈청HBV DNA、응혈매원시간（ PT）、간장B형초성혹CT검사，수방12개월비교료효급불량반응화병사솔。결과 ADV조화ETV조12개월후혈청HBV DNA 음전솔균위100％，비교차이무통계학의의（ P ＞0．05）；ADV조치료12개월HBeAg혈청전환솔급병독학돌파솔위16．7％、2．1％，ETV조분별위14．6％、4．2％，차이비교균무통계학의의（ P ＞0．05）；치료12개월후，2조ALT、TB、Alb、PT균교치료전현저개선（ P ＜0．05），단2조간비교차이균무통계학의의（ P ＞0．05）；2조균미발현유혈청기항（SCr）화유산（LA）초과정상치상한적병례。 ADV조사망1례（2．1％）， ETV조무사망병례。결론아덕복위지혹은체잡위치료저병독재량대상기을간간경화환자균능명현억제HBV DNA복제，개선간공능각항지표，강저실대상적발생，치득림상응용。
Objectives To compare the curative effect of adefovir dipivoxil ( ADV) and entecavir ( ETV) in the treatment of low viral load decompensated liver cirrhosis .Methods From 2011 Jan to 2012 June, 96 cases of low viral load decompensated liver cirrhosis caused by hepatitis B virus ( HBV-DNA <2.0 ×104 copies/ml) were enrolled, according to random number table, they were divided into two groups, 48 cases received adefovir dipivoxil (ADV group), 48 patients re-ceived ticarcillin anti-viral therapy ( ETV group ) , liver function [ alanine amino transferase ( ALT) , total bilirubin ( TB) , al-bumin ( ALB) ] , renal function , alpha fetal protein , hepatitis B markers , serum HBV-DNA, prothrombin time ( PT) , liver B type ultrasound or CT examination were tested in all patients each 1-3 months.All patients were followed up for 12 months to compare the efficacy and adverse reactions and mortality rate .Results After 12 months, serum HBV-DNA negative conver-sion rate in ADV group and ETV group were 100%, the difference was not statistically significant ( P >0.05);treated for 12 months, ADV group’ s HBeAg serum virological breakthrough rate was 16.7% and 2.1%, ETV group were 14.6% and 4.2%, the difference was not statistically significant ( P >0.05); treated for 12 months, 2 groups’ ALT, TB, Alb, PT were significantly improved ( P <0.05), no statistical significance were found between the two groups ( P >0.05).The se-rum creatinine ( SCr) and lactic acid ( LA) more than the normal value of the upper limit were not found in both of the two groups.ADV group died of 1 case (2.1%), and there was no mortality in ETV group.Conclusion Adefovir dipivoxil or en entecavir treatment for low viral load compensated hepatitis B cirrhosis can significantly inhibited HBV -DNA replication, im-prove liver function indicators , reduce incidence of decompensated , its worthy of clinical application .