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目的探讨核苷(酸)类似物初始联合治疗失代偿期乙型肝炎肝硬化的疗效及安全性。方法回顾性分析2008年1月至2011年10月收治的116例乙型肝炎肝硬化患者的临床资料。按不同抗病毒方案分为恩替卡韦(ETV)组(n=38),拉米夫定(LAM)+阿德福韦酯(ADV)组(n=23),替比夫定(LDT)+ADV组(n=16),未抗病毒治疗者作为对照组(n=39)。患者每3个月随访并收集其临床数据,分析各组Child-Pugh评分、病毒学指标、肝癌发生率、生存率及安全性。结果各抗病毒治疗组在1年、2年时Child-Pugh评分较基线均显著下降(P<0.05);LDT+ADV组在2年时e抗原(HBe Ag)阴转率(72.7%)高于ETV组(30.4%,P<0.05);ETV组(0.0%)、LAM+ADV组(8.7%)、LDT+ADV组(0.0%)的2年累积肝衰竭发生率均明显低于对照组(28.2%);各抗病毒治疗组、对照组的2年累积耐药率、肝癌发生率、生存率的差异无统计学意义;各抗病毒治疗组在2年随访中均未出现严重肌病和肾功能损害。结论 LAM+ADV及LDT+ADV可改善失代偿期乙型肝炎肝硬化患者肝功能,LAM+ADV及LDT+ADV的2年疗效和安全性与ETV相似。
Objective To investigate the efficacy and safety of initial combination of nucleoside (acid) analogues in the treatment of decompensated hepatitis B cirrhosis. Methods The clinical data of 116 patients with hepatitis B cirrhosis admitted from January 2008 to October 2011 were retrospectively analyzed. According to different antiviral regimens, the patients were divided into three groups: entecavir (ETV) group (n = 38), lamivudine (LAM) + adefovir dipivoxil group (n = 23), telbivudine (LDT) Group (n = 16) and no antiviral treatment as control group (n = 39). The patients were followed up every 3 months and their clinical data were collected. Child-Pugh score, virological index, incidence of liver cancer, survival rate and safety of each group were analyzed. Results The Child-Pugh scores of all the antiviral treatment groups were significantly lower than those of the baseline at 1 year and 2 years (P <0.05). In the LDT + ADV group, the negative conversion rate of e antigen (HBe Ag) was 72.7% at 2 years The incidence of 2-year cumulative liver failure in ETV group (30.4%, P <0.05) was significantly lower than that in ETV group (0.0%), LAM + ADV group (8.7%) and LDT + ADV group (28.2%). There was no significant difference in cumulative resistance rate, incidence of hepatocellular carcinoma, and survival rate between the antiviral therapy group and the control group in 2 years; no significant myopathy was found in each antiviral treatment group at 2 years of follow-up And renal dysfunction. Conclusions LAM + ADV and LDT + ADV can improve liver function in patients with decompensated hepatitis B cirrhosis. The 2-year efficacy and safety of LAM + ADV and LDT + ADV are similar to those of ETV.