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目的对比分析阿德福韦酯和拉米夫定初始联合与优化治疗失代偿期乙型肝炎肝硬化的临床疗效。方法选择2010年10月~2013年10月在延安大学附属医院进行诊治的失代偿期乙型肝炎肝硬化患者300例,随机分为联合组和优化组,两组均连续治疗1年。联合组采用阿德福韦酯和拉米夫定初始联合治疗,优化组先给予拉米夫定治疗6个月,对患者的血清HBV DNA水平进行检测,如果HBV DNA水平大于1×103拷贝/m L,加用阿德福韦酯,继续治疗6个月。观察和比较两组的HBV DNA复常率、丙氨酸氨基转移酶(ALT)复常率、HBe Ag转阴率,ALT、总胆汁酸(TBIL)、白蛋白水平和腹水消退情况。结果联合组的HBV DNA复常率、ALT复常率和HBe Ag转阴率均明显高于优化组(P<0.05);两组治疗后的ALT、TBIL、白蛋白好转情况和腹水消退情况均明显优于治疗前(P<0.05),联合组的改善情况明显优于优化组(P<0.05);两组治疗前后的肌酸激酶水平和肾功能均无明显差异。结论阿德福韦酯和拉米夫定初始联合治疗失代偿期乙型肝炎肝硬化的临床疗效优于优化治疗。
Objective To compare and analyze the initial curative effect between adefovir dipivoxil and lamivudine combined with optimal treatment of decompensated hepatitis B cirrhosis. Methods 300 patients with decompensated hepatitis B cirrhosis who were diagnosed and treated in the Affiliated Hospital of Yan’an University from October 2010 to October 2013 were randomly divided into the combined group and the optimized group, and the two groups were treated continuously for 1 year. The combination group used adefovir dipivoxil and lamivudine initial combination therapy, the optimization group first given lamivudine treatment for 6 months, the serum HBV DNA levels were detected, if the HBV DNA level is greater than 1 × 103 copies / m L, plus adefovir dipivoxil continued treatment for 6 months. The normalization rate of HBV DNA, the normalization rate of alanine aminotransferase (ALT), the conversion rate of HBeAg, ALT, total bile acid (TBIL), albumin level and regression of ascites were observed and compared between the two groups. Results The rates of HBV DNA abnormality, ALT normalization rate and HBeAg negative conversion rate in the combination group were significantly higher than those in the optimized group (P <0.05). The ALT, TBIL, albumin recovery and ascites regression (P <0.05). The improvement in the combined group was significantly better than that in the optimized group (P <0.05). There was no significant difference in creatine kinase and renal function between the two groups before and after treatment. Conclusion The initial combination of adefovir dipivoxil and lamivudine is superior to optimal treatment in decompensated hepatitis B cirrhosis.