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目的探讨不同核苷类药物对乙型肝炎肝硬化失代偿期患者肝功能、病毒学及并发症的影响。方法选取该院消化内科2010年1月—2015年12月收治的乙型肝炎肝硬化失代偿期患者87例。按照患者选择服用的核苷类药物分为拉米夫定组23例,阿德福韦酯组39例,恩替卡韦组25例。随访3年,记录三组患者治疗前及治疗后3年的肝功能、HBV DNA水平及并发症发生情况。结果治疗前三组患者的肝功能、HBV-DNA载量、腹腔积液的发生率、自发性腹膜炎的发生率、肝性脑病的发生率差异无统计学意义(P>0.05)。治疗后三组患者肝功能均有所改善,且恩替卡韦组肝功能各项指标较其他二组明显下降,差异有统计学意义(P<0.05)。治疗后三组患者HBV-DNA载量均较前降低,且恩替卡韦组较其他二组明显下降,差异有统计学意义(P<0.05)。治疗后三组患者腹腔积液、自发性腹膜炎、肝性脑病的发生率均较前降低,但三组比较差异无统计学意义。结论核苷类抗病毒药物治疗乙型肝炎肝硬化能够明显改善肝功能,降低HBV-DNA载量,减少并发症的发生,其中恩替卡韦临床效果优于拉米夫定及阿德福韦酯,疗效较为突出。
Objective To investigate the effect of different nucleoside drugs on liver function, virology and complications in decompensated patients with hepatitis B cirrhosis. Methods A total of 87 patients with decompensated hepatitis B cirrhosis admitted to our hospital from January 2010 to December 2015 were enrolled. According to the patients choose to take nucleosides drugs were divided into lamivudine group 23 cases, adefovir dipivoxil group 39 cases, entecavir group 25 cases. The patients were followed up for 3 years. The liver function, HBV DNA level and complication of the three groups before and after 3 years of treatment were recorded. Results There was no significant difference in the incidence of hepatic function, HBV-DNA load, ascites, spontaneous peritonitis and hepatic encephalopathy between the three groups before treatment (P> 0.05). After treatment, the liver function of the three groups improved, and the indexes of liver function in entecavir group were significantly lower than the other two groups (P <0.05). After treatment, the HBV-DNA load of the three groups was lower than before, and the entecavir group was significantly lower than the other two groups, the difference was statistically significant (P <0.05). After treatment, the incidence of ascitic fluid, spontaneous peritonitis and hepatic encephalopathy were lower in the three groups than in the previous three groups, but the differences between the three groups were not statistically significant. Conclusion Nucleoside antiviral treatment of hepatitis B cirrhosis can significantly improve liver function, reduce HBV-DNA load and reduce the incidence of complications, of which entecavir clinical effect is superior to lamivudine and adefovir dipivoxil, efficacy More prominent.