CAJ | 학술논문

目的：探讨恩替卡韦联合阿德福韦酯治疗对拉米夫定耐药乙型肝炎肝硬化的临床疗效，为临床治疗提供参考。方法选择117例拉米夫定耐药乙型肝炎肝硬化患者，按照治疗方式分为观察组及对照组，观察组60例使用恩替卡韦联合阿德福韦酯治疗，对照组57例使用拉米夫定联合阿德福韦酯治疗，对比两组患者 HBeAg 血清转换率、HBV-DNA 转阴率、肝功能指标、肝功能 Child-pugh 评分。结果观察组治疗24周、48周 HBV-DNA 转阴率分别为75．00％、95．00％，高于对照组，对比差异有统计学意义（χ2＝4．251，P ＝0．024；χ2＝4．535，P ＝0．018）；观察组 ALB、ALT、TBiL、PT 改善均优于对照组，对比差异有统计学意义（t ＝4.229，P ＝0．025；t ＝6．214，P ＝0．008；t ＝5．514，P ＝0．014；t ＝5．233，P ＝0．017）；观察组治疗后 CTP 为（7．15±1.05）分，明显低于对照组的（8．86±1．47）分，对比差异有统计学意义（t ＝5．874，P ＝0．010）；观察组与对照组不良反应发生率对比差异均无统计学意义（P ＞0．05）。结论恩替卡韦联合阿德福韦酯治疗拉米夫定耐药乙型肝炎肝硬化临床效果好，利于改善肝功能、抑制 HBV 复制，值得临床推广应用。
목적：탐토은체잡위연합아덕복위지치료대랍미부정내약을형간염간경화적림상료효，위림상치료제공삼고。방법선택117례랍미부정내약을형간염간경화환자，안조치료방식분위관찰조급대조조，관찰조60례사용은체잡위연합아덕복위지치료，대조조57례사용랍미부정연합아덕복위지치료，대비량조환자 HBeAg 혈청전환솔、HBV-DNA 전음솔、간공능지표、간공능 Child-pugh 평분。결과관찰조치료24주、48주 HBV-DNA 전음솔분별위75．00％、95．00％，고우대조조，대비차이유통계학의의（χ2＝4．251，P ＝0．024；χ2＝4．535，P ＝0．018）；관찰조 ALB、ALT、TBiL、PT 개선균우우대조조，대비차이유통계학의의（t ＝4.229，P ＝0．025；t ＝6．214，P ＝0．008；t ＝5．514，P ＝0．014；t ＝5．233，P ＝0．017）；관찰조치료후 CTP 위（7．15±1.05）분，명현저우대조조적（8．86±1．47）분，대비차이유통계학의의（t ＝5．874，P ＝0．010）；관찰조여대조조불량반응발생솔대비차이균무통계학의의（P ＞0．05）。결론은체잡위연합아덕복위지치료랍미부정내약을형간염간경화림상효과호，리우개선간공능、억제 HBV 복제，치득림상추엄응용。
Objective To investigate the clinical effect of entecavir combined with adefovir dipivoxil in the treatment of lamivudine -resistant hepatitis B cirrhosis,to provide a reference for clinical treatment.Methods 117 cases of liver cirrhosis with lamivudine resistance were selected,they were divided into the control group and the observation group according to treatment.60 cases in the observation group used entecavir and adefovir combination therapy,57 cases in the control group was given lamivudine combined with adefovir dipivoxil.The HBeAg conversion rate,HBV -DNA negative rate,liver function,liver function Child -pugh score were compared between two groups.Results After treatment for 24 weeks,48 weeks,the HBV -DNA negative conversion rates in the observation group were 75.00%, 95.00%,which were higher than those in the control group,the differences were statistically significant (χ2 =4.251, P =0.024;χ2 =4.535,P =0.018).In the observation group,ALB,ALT,TBiL,PT improved better than the control group,the differences were statistically significant(t =4.229,P =0.025;t =6.214,P =0.008;t =5.514,P =0.014;t =5.233,P =0.017).After treatment,CTP of the observation group was (7.15 ±1.05)points,which was significantly lower than the control group (8.86 ± 1.47)points,the difference was statistically significant (t =5.874,P =0.010).The incidence rate of adverse reactions between the two groups showed no statistically significant difference (P >0.05).Conclusion Entecavir combined with adefovir dipivoxil therapy has good effect for lamivudine -resistant liver cirrhosis,which will help to improve liver function,inhibit HBV replication,it is worthy of clinical application.