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目的核苷类似物用治疗发生拉米夫定耐药的肝硬化失代偿期患者,观察其疗效及安全性。方法选择拉米夫定治疗后产生耐药的HBsAg、HBeAb和HBcAb阳性、HBVDNA>105copies/L的肝硬化失代偿期患者51例,应用不同核苷类似物抗病毒治疗,于治疗24周,48周后观察疗效及不良反应。结果治疗后24周,48周后血清HBV-DNA水平中位数下降幅度、病毒学应答率及生化学应答率均明显优于治疗前(P<0.05);血清生化指标好转,与治疗前相比较有显著性差异(P<0.01);肝功能Child-Pugh计分好转,与治疗前相比较有显著性差异(P<0.01);两组比较,差异无统计学意义。结论阿德福韦联合拉米夫定、恩替卡韦(ETV)治疗拉米夫定耐药的肝硬化失代偿期患者均可以较快出现血清病毒学应答,能改善肝功能,减缓病情发展,安全性好。
The purpose of nucleoside analogues used in the treatment of lamivudine-resistant patients with decompensated cirrhosis and observed its efficacy and safety. Methods Fifty-one patients with HBsAg, HBeAb and HBcAb-positive patients with decompensated liver cirrhosis with HBVDNA> 105copies / L after lamivudine treatment were selected and treated with different nucleoside analogs for antiviral therapy. After treatment for 24 weeks, After 48 weeks to observe the efficacy and adverse reactions. Results After 24 weeks and 48 weeks of treatment, the median decrease of HBV DNA level, the virological response rate and the biochemical response rate were significantly better than those before treatment (P <0.05). The serum biochemical indexes improved, (P <0.01). Child-Pugh scores of liver function improved compared with those before treatment (P <0.01). There was no significant difference between the two groups. Conclusions adefovir combined with lamivudine and entecavir (ETV) can delay the serum virological response in patients with lamivudine-resistant decompensated liver cirrhosis, improve liver function, slow the progression of disease, Good sex.