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目的:分析核苷类药物对乙肝伴肝硬化患者的临床疗效和耐药性。方法:选取2011年3月—2014年3月诊治的乙肝伴肝硬化患者113例,将其分为对照组(n=36)、恩替卡韦组(A组,n=38例)和阿德福韦酯组(B组,n=39例);对照组患者均单纯给予内科常规治疗,A组患者在对照组治疗基础上均给予恩替卡韦治疗,B组患者均给予阿德福韦酯治疗,比较3组患者治疗后的临床疗效以及恩替卡韦、阿德福韦酯的耐药性。结果:A组患者治疗后肝功能各指标(ALT、ALB、TBIL)明显低于B组和对照组(P<0.05);B组上述指标明显低于对照组,A组HBVDNA转阴率和HBe Ag血清转换率明显高于B组和对照组(P<0.05);治疗过程中2例对照组患者于治疗36周时因并发消化系统严重出血而病死,2例于治疗48周时因继发重症乙型肝炎而病死,其病死率为11.11%(4/36);A组患者治疗48周时出现耐药现象2例,其耐药的发生率为5.26%(2/38),B组患者在治疗过程中无发现任何耐药现象。结论:核苷类药物用于乙肝伴肝硬化患者抗病毒治疗,应首选恩替卡韦,为避免耐药现象的出现,待病情改善后改用阿德福韦酯继续抗病毒治疗。
Objective: To analyze the clinical efficacy and drug resistance of nucleosides in patients with hepatitis B and cirrhosis. Methods: A total of 113 patients with hepatitis B and cirrhosis who were diagnosed and treated from March 2011 to March 2014 were selected and divided into control group (n = 36), entecavir group (group A, n = 38) and adefovir (Group B, n = 39). The patients in the control group were given conventional medical treatment only. Patients in group A were treated with entecavir on the basis of the control group, while those in group B were treated with adefovir dipivoxil. Group clinical efficacy of treatment and entecavir, adefovir dipivoxil resistance. Results: The indexes of ALT, ALB and TBIL in group A were significantly lower than those in group B and control (P <0.05). The above indexes in group B were significantly lower than those in control group Ag serum conversion rate was significantly higher than the B group and the control group (P <0.05); during the treatment of two patients in the control group at the 36th week of treatment due to severe digestive bleeding and died, 2 cases of 48 weeks of treatment due to secondary Severe hepatitis B and died, the case fatality rate was 11.11% (4/36); A group of patients 48 weeks after the emergence of drug resistance in 2 cases, the incidence of drug resistance was 5.26% (2/38), B Patients in the course of treatment found no resistance. Conclusion: Nucleoside drugs for the treatment of hepatitis B patients with antiviral therapy should be the first choice of entecavir, in order to avoid the emergence of drug resistance, adefovir dipivoxil to be continued until after the disease was improved antiviral therapy.