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目的:观察拉米夫定联合水飞蓟宾葡甲胺治疗慢性乙型肝炎活动性肝硬化2～5年的长期疗效。方法:选择活动性肝炎肝硬化患者90例,采用分层随机抽样法分为两组。治疗组:采用水飞蓟宾葡甲胺和拉米夫定联合治疗;对照组:采用退黄、降酶、抗纤维化、支持及对症处理,疗程6～67月,疗程中位数31.4月。对血清病毒水平、肝功能、合并症、肝癌的发生率、病死率进行观察。结果:两组HBV DNA阴转、HBeAg转换间差异均有统计学意义(P<0.05);治疗组患者12,24,36,37～67月,HBV DNA的YMDD变异率分别为11.4%,22.7%, 34.1%,38.6%。治疗组未发生YMDD变异病例的总胆红素(TBil)、Child-pugh分级积分下降,白蛋白(Alb)升高,与对照组相比,差异均有统计学意义(P<0.05);两组合并症的发生率、死亡率间差异亦均P<0.05;肝癌的发生率,两组差异无显著性(P>0.05)。结论:水飞蓟宾葡甲胺联合拉米夫定治疗活动性肝炎肝硬化,可抑制病毒复制,使YMDD的累计变异率降低,肝功能改善,合并症的发生减少、患者的病死率降低。
Objective: To observe the long-term efficacy of lamivudine combined with silybin-meglumine in the treatment of active cirrhosis of chronic hepatitis B for 2 to 5 years. Methods: Ninety patients with active cirrhosis were divided into two groups by stratified random sampling. The treatment group: the use of silybin meglumine and lamivudine combination therapy; control group: the use of yellow, Jiangni, anti-fibrosis, support and symptomatic treatment, course of 6 to 67 months, the median treatment time 31.4 months . Serum levels of virus, liver function, complications, the incidence of liver cancer, mortality was observed. Results: The differences of HBV DNA negative conversion and HBeAg conversion between the two groups were statistically significant (P <0.05). The YMDD mutation rates of HBV DNA in treatment group were 11.4%, 22.7%, 12.7% %, 34.1%, 38.6%. Compared with the control group, the difference of TBil, Child-pugh score and Alb in treatment group did not change (P <0.05); The incidence of comorbidity and mortality were also P <0.05; the incidence of liver cancer, no significant difference between the two groups (P> 0.05). Conclusion: Silybin combined with lamivudine in the treatment of active cirrhosis can inhibit the replication of virus, reduce the cumulative mutation rate of YMDD, improve the liver function, reduce the incidence of comorbidity and reduce the mortality of patients.