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目的随访α-干扰素、拉米夫定和拉米夫定联合苦参碱防治乙型肝炎肝衰竭生存者的中期疗效。方法在多中心选择亚急性或慢加亚急性乙型肝炎肝衰竭生存者(A组)110例,分别接受α-干扰素、拉米夫定和拉米夫定联合苦参碱治疗6个月;选择慢性乙型肝炎肝衰竭生存者(B组)110例,分别给予拉米夫定和拉米夫定联合苦参碱治疗6个月。随访18个月。结果在随访18个月时,A组患者全部生存,其中25.6%(10/39)接受α-干扰素治疗的患者,改用拉米夫定治疗,21.1%(15/71)接受拉米夫定或拉米夫定联合苦参碱治疗的患者改用阿德福韦酯治疗;B组接受拉米夫定治疗的患者死亡5例(9.4%),接受拉米夫定联合苦参碱治疗的患者死亡6例(10.5%),18.2%(18/99)生存者改用阿德福韦继续治疗。拉米夫定治疗使超过80%患者血清HBVDNA转阴,α-干扰素或拉米夫定联合苦参碱治疗患者HBeAg阴转和HBeAg/抗-HBe血清学转换率不比单用拉米夫定治疗者高。结论乙型肝炎肝衰竭生存者长期口服核苷类抗病毒药对阻断肝纤维化的发展有明显的疗效。由于本组α-干扰素和苦参碱的治疗时间相对较短,其中长期疗效还有待进一步探讨。
Objective To investigate the medium-term efficacy of α-interferon, lamivudine and lamivudine in combination with matrine in the prevention and treatment of hepatitis B patients with liver failure. Methods A total of 110 patients with subacute or subacute subacute hepatic failure in liver failure (group A) were enrolled in this study. Patients were treated with α-interferon, lamivudine and lamivudine plus matrine for 6 months 110 patients with chronic hepatitis B liver failure survivors (group B) were given lamivudine and lamivudine combined with matrine for 6 months respectively. Follow-up 18 months. Results All the patients in group A survived at 18 months of follow-up. Among them, 25.6% (10/39) received interferon-α, while lamivudine was used instead of lamivudine, while 21.1% (15/71) received lamivudine Adefovir dipivoxil was given to patients given lamivudine plus lamivudine plus matrine; 5 patients (9.4%) died of lamivudine in group B who received lamivudine plus matrine Of patients died in 6 cases (10.5%), 18.2% (18/99) of survivors to adefovir continue treatment. Lamivudine treatment over 80% of patients with serum HBVDNA negative, interferon alpha or lamivudine combined with matrine in patients with HBeAg negative and HBeAg / anti-HBe seroconversion rate than with lamivudine alone High treatment. Conclusion Long-term oral administration of nucleoside antiviral agents in patients with hepatitis B liver failure has obvious curative effect on blocking the development of hepatic fibrosis. As the group of α-interferon and matrine treatment time is relatively short, including long-term efficacy remains to be further explored.