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[目的]探讨老年乙肝后肝硬化失代偿期患者应用拉米夫定联合前列腺素E治疗的临床疗效。[方法]选取我院102例老年乙肝后肝硬化失代偿期患者,采用完全随机化原则将其分为2组,每组各51例,其中对照组患者采用拉米夫定等常规药物治疗,观察组在此基础上给予前列腺素E治疗。观察比较2组患者治疗前后谷丙转氨酶、谷草转氨酶、血清总胆红素、白蛋白、临床疗效及不良反应发生情况。[结果]2组患者治疗前谷丙转氨酶、谷草转氨酶、血清总胆红素、白蛋白比较,差异均无统计学意义(P>0.05)。治疗后,对照组患者谷丙转氨酶为(90.4±12.2)U/L,明显低于治疗前[(249.8±52.6)U/L,t=21.082,P<0.05];谷草转氨酶为(89.6±11.7)U/L,明显低于治疗前[(279.6±66.1)U/L,t=20.213,P<0.05];血清总胆红素为(47.9±13.8)μmol/L,明显低于治疗前[(72.6±18.2)μmol/L,t=7.723,P<0.05];白蛋白为(30.3±5.9)g/L,明显高于治疗前[(23.8±5.2)g/L,t=-5.902,P<0.05]。治疗后,观察组患者谷丙转氨酶为(57.8±7.7)U/L,明显低于治疗前[(253.2±53.3)U/L,t=25.912,P<0.05];谷草转氨酶为(46.2±6.0)U/L,明显低于治疗前[(280.5±67.2)U/L,t=24.801,P<0.05];血清总胆红素为(28.5±8.1)μmol/L,明显低于治疗前[(72.9±18.0)μmol/L,t=16.064,P<0.05];白蛋白为(33.1±6.2)g/L,明显高于治疗前[(23.4±5.0)g/L,t=-8.697,P<0.05]。且观察组以上指标改善幅度均高于对照组,差异有统计学意义(t=16.137,23.572,8.658,-2.336,P<0.05)。观察组总有效率为58.8%,明显高于对照组31.4%,差异有统计学意义(!2=7.761,P<0.01)。观察组患者无严重不良反应发生,对照组出现3例腹胀腹泻患者,差异无统计学意义(!2=3.091,P>0.05)。[结论]老年乙肝后肝硬化失代偿期患者应用拉米夫定联合前列腺素E治疗可明显改善肝功能,提高临床疗效,且具有较高的安全性,值得应用推广于临床。
[Objective] To investigate the clinical efficacy of lamivudine plus prostaglandin E in elderly patients with decompensated hepatitis B after liver cirrhosis. [Methods] A total of 102 elderly patients with decompensated hepatitis B after liver cirrhosis were selected and divided into two groups according to the principle of complete randomization. Each group had 51 patients. The patients in the control group were treated with conventional drugs such as lamivudine , The observation group on this basis given prostaglandin E treatment. The levels of alanine aminotransferase, aspartate aminotransferase, serum total bilirubin and albumin before and after treatment were observed and compared between two groups. The clinical efficacy and adverse reactions were observed. [Results] There were no significant differences in ALT, AST, serum total bilirubin and albumin between the two groups before treatment (P> 0.05). After treatment, the alanine aminotransferase in the control group was (90.4 ± 12.2) U / L, which was significantly lower than that before treatment [(249.8 ± 52.6) U / L, t = 21.082, P < ) Was significantly lower than that before treatment [(279.6 ± 66.1) U / L, t = 20.213, P <0.05]; serum total bilirubin was (47.9 ± 13.8) μmol / L, (72.6 ± 18.2) μmol / L, t = 7.723, P <0.05]; albumin was (30.3 ± 5.9) g / L and significantly higher than that before treatment (23.8 ± 5.2 g / P <0.05]. After treatment, the alanine aminotransferase in the observation group was (57.8 ± 7.7) U / L, significantly lower than that before treatment [(253.2 ± 53.3) U / L, t = 25.912, P < ) Was significantly lower than that before treatment [(280.5 ± 67.2) U / L, t = 24.801, P <0.05]; serum total bilirubin was (28.5 ± 8.1) μmol / L, (72.9 ± 18.0) μmol / L, t = 16.064, P <0.05]; albumin was (33.1 ± 6.2) g / L and significantly higher than that before treatment (23.4 ± 5.0 g / P <0.05]. The improvement of the above indexes in the observation group were higher than that in the control group, the difference was statistically significant (t = 16.137,23.572,8.658, -2.336, P <0.05). The total effective rate in the observation group was 58.8%, which was significantly higher than that in the control group (31.4%). The difference was statistically significant (! 2 = 7.761, P <0.01). There were no serious adverse reactions in the observation group. There were 3 cases of abdominal distension and diarrhea in the control group, with no significant difference (2 2 = 3.091, P> 0.05). [Conclusion] The application of lamivudine plus prostaglandin E in patients with decompensated hepatitis B after liver cirrhosis can obviously improve liver function, improve clinical curative effect, and have higher safety. It is worth to be applied in clinic.