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目的观察核苷类药物治疗乙型肝炎肝硬化失代偿期的疗效。方法对96例乙型肝炎肝硬化失代偿期患者随机分组,所有患者在保肝对症治疗的基础上,分别给予拉米夫定(A组)100mg/d、阿德福韦酯(B组)10mg/d、恩替卡韦(C组)0.5mg/d口服,疗程为48周,同时设立保守治疗组(D组),观察所有患者临床症状、体征、肝功能变化、凝血酶原时间活动度(PTA)、HBV-DNA定量、HBeAg阴转、HBeAg/HBeAb转换情况。结果通过抗病毒治疗,A、B、C三组患者无一例死亡,临床表现、体征、肝功能、PTA均有明显改善,HBeAg血清转换率三组分别为20%、8%、23%,三者统计学处理有显著差异(P<0.05),HBV-DNA阴转率三组分别为48%、28%、68.2%,组间比较有显著差异(P<0.05)。D组疗效最差,死亡3例,抗病毒治疗组与保守治疗组疗效有显著差异(P<0.01)。结论乙型肝炎肝硬化失代偿期患者应行抗病毒治疗,可首先选用拉米夫定或恩替卡韦,为防止应用拉米夫定病毒变异,可在病情好转后改用阿德福韦酯继续治疗。
Objective To observe the effect of nucleoside drugs in the treatment of decompensated liver cirrhosis. Methods Ninety-six patients with decompensated hepatitis B were randomized. All patients were given lamivudine (group A) 100mg / d, adefovir dipivoxil (group B) ), Entecavir (group C) 0.5mg / d orally for 48 weeks. At the same time, a conservative treatment group (group D) was established. The clinical symptoms, signs, changes of hepatic function and prothrombin time activity PTA), HBV-DNA quantification, HBeAg negative conversion, HBeAg / HBeAb conversion. Results There was no death in group A, B, and C after antiviral treatment. The clinical manifestations, signs, liver function and PTA were all significantly improved. The HBeAg seroconversion rates in the three groups were 20%, 8%, 23% (P <0.05). The negative conversion rate of HBV-DNA in three groups was 48%, 28% and 68.2% respectively, there was significant difference between the two groups (P <0.05). Group D had the poorest efficacy and died of 3 cases. There was significant difference between the antiviral and conservative treatment groups (P <0.01). Conclusion Hepatitis B patients with decompensated liver cirrhosis should be treated with antiviral therapy. Lamivudine or entecavir may be the first choice. In order to prevent the application of lamivudine mutation, Adefovir dipivoxil may be used after the condition is improved treatment.