摘要
目的观察替比夫定(LdT)治疗乙型肝炎(乙肝)肝硬化患者的疗效。方法采用随机开放对照研究方法,将100例乙肝肝硬化患者随机分成两组,LdT组50例,拉米夫定(LAM)组50例,疗程均为48周。观察患者的病毒学、生化学、血清学及肝脏合成功能指标、Child评分及部分组织学变化情况。结果乙肝肝硬化患者经LdT治疗24周及48周后,HBV DNA水平由基线的(6.62±1.67)lg拷贝/ml分别降至(3.27±1.33)、(3.17±1.45)lg拷贝/ml,24周、48周HBV DNA阴转率为48.00%(24/50)和54.00%(27/50),与LAM组差异无统计学意义(χ2=0.005,P=0.945);LdT组初始HBeAg阳性患者29例,治疗结束时HBeAg阴转率为37.93%(11/29),转换率为20.69%(6/29),与LAM组差异无统计学意义(χ2=0.042,P=0.838);LdT组治疗结束时丙氨酸氨基转移酶(ALT)水平由基线的(103.17±38.20)IU/L降至(45.38±7.03)IU/L(t=6.302,P<0.05),Child评分及失代偿期组中反映肝脏合成指标的白蛋白及胆碱酯酶也均较治疗前基线水平有不同程度的改善(P<0.05);LAM组有2人死亡,LdT组1人死亡,均死于肝硬化相关并发症,两组不良反应的发生率差异无统计学意义(χ2=1.895,P=0.169);LAM治疗组有4例、LdT治疗组有2例于治疗中出现病毒学突破,检测出现YMDD变异,给予加用阿德福韦酯10mg,每日1次治疗,两组间病毒耐药率差异无统计学意义。肝脏组织学检查可见LdT治疗前后肝脏炎症及纤维化程度的改善。结论 LdT具有快速强效抑制病毒、不良反应少等特点,并能改善乙肝肝硬化患者肝组织炎症及纤维化程度,对于HBV活跃复制的肝硬化患者有积极治疗作用。
Objective To evaluate the efficacy of telbivudine in the treatment of hepatitis B virus （HBV） -re- lated liver cirrhosis. Methods A total of 100 patients with HBV-related liver cirrhosis were randomly divided into 2 groups： 50 in the telbivudine group and 50 in the lamivudine group. Serum alanine aminotransferase （ALT） and HBV DNA levels, HBV e antigen （HBeAg） loss and seroconversion, Child score and improve- ment in histology of these two groups were evaluated and compared. Results In the telbivudine group, the median HBV DNA levels was dropped significantly at both week 24 and week 48 （from 6.62 to 3.27 lg, 3.17 lg copies/ml, respectively）, ALT levels also declined, the accumulative HBeAg loss was 37.93% （11/29） at week 48 and HBeAg seroconversion rate was 20.69% （6/29） . CTP scores and hepatic function parameters and pathologic examination improved at different degrees. However, all these changes and side-effect rate didn＇t show marked difference comparing to that in the lamivudine group （P〈0.05）. Conclusions The thera- peutic effect of telbivudine for the treatment of HBV-related liver cirrhosis is potent, fast. Results from this study support previous observations that telbivudine is effective for the improvement of virological, serologi- cal, biochemical and histological status in the treatment of HBV-related liver cirrhosis.
出处
《中国病毒病杂志》
CAS
2013年第5期387-391,共5页
Chinese Journal of Viral Diseases
