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目的探讨替比夫定、阿德福韦酯联用治疗失代偿期乙肝肝硬化的疗效及安全性。方法失代偿期乙肝肝硬化患者118例,随机分为联合组和对照组,各59例。对照组采用恩替卡韦分散片治疗,联合组采用替比夫定、阿德福韦酯联合治疗。比较两组患者治疗前及治疗48周时的血清谷丙转氨酶(ALT)、白蛋白(ALB)水平、总胆红素(TBil)、凝血酶原活动度(PTA)及Child-pugh评分情况,同时比较两组治疗12、24、48周时的乙型肝炎病毒的脱氧核糖核酸(HBV-DNA)转阴率、乙型肝炎E抗原(HBeAg)血清学转换率及不良反应情况。结果两组治疗48周时的ALT、TBil水平及Child-pugh评分明显低于治疗前,ALB、PTA水平明显高于治疗前,差异有统计学意义(P<0.05);治疗前后两组ALT、ALB、TBil、PTA水平及Child-pugh评分比较差异无统计学意义(P>0.05)。两组患者在治疗12、24、48周时的HBV-DNA转阴率、HBeAg血清学转换率比较差异无统计学意义(P>0.05)。两组无明显不良反应发生。结论替比夫定联合阿德福韦酯治疗失代偿期乙肝肝硬化能取得较好的效果,安全性较高,值得临床参考。
Objective To investigate the efficacy and safety of telbivudine and adefovir dipivoxil in the treatment of decompensated hepatitis B cirrhosis. Methods 118 patients with decompensated hepatitis B cirrhosis were randomly divided into combined group and control group, 59 cases each. The control group treated with entecavir dispersible tablets, the combination group with telbivudine, adefovir dipivoxil combination therapy. Serum alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBil), prothrombin activity (PTA) and Child-pugh scores were compared between the two groups before and 48 weeks after treatment. At the same time, HBV DNA negative rate, HBeAg seroconversion rate and adverse reaction of hepatitis B virus at 12, 24 and 48 weeks were compared between the two groups. Results The levels of ALT, TBil and Child-pugh scores at 48 weeks after treatment in both groups were significantly lower than those before treatment. The levels of ALB and PTA in the two groups were significantly higher than those before treatment (P <0.05) ALB, TBil, PTA levels and Child-pugh score was no significant difference (P> 0.05). The HBV-DNA negative rate and HBeAg seroconversion rate of the two groups at 12, 24 and 48 weeks after treatment were not significantly different (P> 0.05). No significant adverse reactions occurred in both groups. Conclusion telbivudine combined with adefovir dipivoxil treatment of decompensated hepatitis B cirrhosis can achieve better results, higher safety, it is worth clinical reference.