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目的观察恩替卡韦联合阿德福韦酯治疗高病毒载量乙型肝炎肝硬化临床疗效。方法选择2014年1月至2015年4月收治的高病毒载量HBV-DNA肝硬化患者78例,随机分成治疗组和对照组,各39例。治疗组予以恩替卡韦分散片联合阿德福韦酯,对照组单用恩替卡韦分散片。分别观察在治疗12、24、48周时治疗组和对照组HBV-DNA阴转率、HBe Ag转换率、肝脏Child-Pugh评分。结果治疗12、24、48周时治疗组HBV-DNA阴转率(66.67%、74.36%、94.87%)均高于同期对照组(53.85%、64.10%、71.79%),在48周时有统计学差异(P<0.01)。治疗24、48周时HBe Ag转换率治疗组(10.26%、25.64%)高于同期对照组(5.12%、7.69%),48周时有统计学差异(P<0.05)。治疗12、24、48周时肝脏Child-Pugh评分治疗组(7.13±1.78、6.47±1.79、5.25±1.49)比对照组(7.24±2.64、6.75±2.02、6.17±1.39)好转明显,48周改善显著(P<0.01)。结论初始联合恩替卡韦和阿德福韦酯治疗高病毒载量乙型肝炎肝硬化具有较强的抗病毒的作用,可以提高应答率,降低耐药率,长期使用比单用恩替卡韦疗效更加明显。
Objective To observe the clinical efficacy of entecavir plus adefovir dipivoxil in the treatment of hepatitis B cirrhosis with high viral load. Methods Seventy-eight patients with high viral load HBV-DNA cirrhosis admitted from January 2014 to April 2015 were randomly divided into treatment group and control group, 39 cases in each group. Treatment group entecavir dispersible tablets combined with adefovir dipivoxil, the control group with entecavir dispersible tablets. HBV-DNA negative conversion rate, HBeAg conversion rate and liver Child-Pugh score of the treatment group and the control group were observed at 12, 24 and 48 weeks after treatment. Results The negative conversion rate of HBV-DNA in the treatment group (66.67%, 74.36%, 94.87%) was significantly higher than that in the control group (53.85%, 64.10%, 71.79%) at 12, 24 and 48 weeks of treatment, Learning difference (P <0.01). At 24 and 48 weeks of treatment, HBeAg conversion rates in the treatment group (10.26%, 25.64%) were significantly higher than those in the control group (5.12%, 7.69%) at 48 and 48 weeks (P <0.05). Compared with the control group (7.24 ± 2.64, 6.75 ± 2.02, 6.17 ± 1.39), the treatment group of Child-Pugh score at 12, 24 and 48 weeks of treatment showed significant improvement, 48 weeks improvement Significant (P <0.01). Conclusions The initial combination of entecavir and adefovir dipivoxil in the treatment of high viral load hepatitis B cirrhosis has a strong anti-viral effect, which can improve the response rate and reduce the drug resistance rate. The long-term use is more obvious than that of entecavir alone.