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目的探讨拉米夫定联合阿德福韦酯与单用恩替卡韦治疗乙型病毒性肝炎肝硬化失代偿期的临床疗效以及安全性。方法 97例乙型肝炎肝硬化失代偿期患者,随机分为A组(49例)与B组(48例)。A组患者在综合及对症支持治疗基础上加用恩替卡韦进行治疗,B组患者在综合及对症支持治疗基础上,加用拉米夫定与阿德福韦酯进行治疗。对两组患者进行为期48周的随访,观察两组患者肝功能、Child评分、HBV DNA转阴率、发生病毒学突破及患者死亡率。结果治疗后,两组患者肝功能及Child评分与治疗前比较明显好转,差异均有统计学意义(P<0.05);治疗后两组比较,差异无统计学意义(P>0.05)。A组患者HBV DNA转阴率83.7%,患者死亡率4.2%,有1例发生病毒学突破;B组患者HBV DNA转阴率64.2%,患者死亡率4.2%,有1例发生病毒学突破;比较差异无统计学意义(P>0.05)。结论拉米夫定联合阿德福韦酯与单用恩替卡韦治疗乙型病毒性肝炎肝硬化失代偿期临床效果相当,均能较好抑制HBV的复制,改善患者肝功能,适合临床推广使用。
Objective To investigate the clinical efficacy and safety of lamivudine combined with adefovir dipivoxil and entecavir alone in the treatment of decompensated cirrhosis of patients with viral hepatitis B (HBV). Methods 97 patients with decompensated hepatitis B cirrhosis were randomly divided into group A (n = 49) and group B (n = 48). Patients in group A were treated with entecavir on the basis of comprehensive and symptomatic supportive care. Patients in group B were treated with lamivudine and adefovir dipivoxil on the basis of comprehensive and symptomatic supportive care. The two groups of patients were followed up for 48 weeks, liver function, Child score, HBV DNA negative rate, virological breakthrough and patient mortality were observed. Results After treatment, the liver function and Child score of the two groups improved significantly compared with those before treatment, the differences were statistically significant (P <0.05). There was no significant difference between the two groups after treatment (P> 0.05). A group of patients with HBV DNA negative rate of 83.7%, the patient mortality rate of 4.2%, 1 case of virological breakthrough; B group of patients with HBV DNA negative rate of 64.2%, the patient mortality rate of 4.2%, 1 case of virological breakthrough; The difference was not statistically significant (P> 0.05). Conclusions lamivudine combined with adefovir dipivoxil and entecavir alone treatment of hepatitis B cirrhosis of the decompensated phase of clinical efficacy are better able to inhibit the replication of HBV to improve liver function in patients for clinical use.