拉米夫定与恩替卡韦治疗慢性乙型肝炎慢加急性肝功能衰竭的对比研究

发布时间：2018-03-12 10:57

  本文选题：乙型肝炎　切入点：慢加急性肝功能衰竭　出处：《成都医学院学报》2016年01期 　论文类型：期刊论文

【摘要】：目的对比拉米夫定和恩替卡韦在治疗慢性乙型肝炎合并慢加急性肝衰竭方面的疗效和安全性。方法将62例慢性乙型肝炎慢加急性肝衰竭患者随机分为拉米夫定治疗组(LAM组)和恩替卡韦治疗组(ETV组),每组各31例。除常规内科综合治疗外,LAM组口服拉米夫定(LAM)100mg,1次/d;ETV组口服恩替卡韦(ETV)500mg,1次/d。对比两组治疗前后血清丙氨酸氨基转移酶(ALT)、白蛋白(Alb)、总胆红素(TBil)、凝血酶原活动度(PTA)及病毒学指标变化,并采用终末期肝病模型(MELD)评估两组患者病情改善情况。结果 24周时LAM组生存率为77.4%(24/31),低于ETV组的87.1%(27/31),差异无统计学意义(P0.05)。两组治疗后12周、24周时ALT和TBil均明显下降(P0.05或P0.01),Alb和PTA均明显上升(P0.05或P0.01),但两组间比较,差异无统计学意义(P0.05)。治疗后12周、24周时两组MELD评分和HBV DNA定量均明显下降(P0.05或P0.01);治疗后24周时,ETV组MELD评分低于LAM组(P0.01),ETV组HBV DNA转阴率高于LAM组,差异有统计学意义(P0.05)。结论短期内LAM和ETV均能改善慢性乙型肝炎慢加急性肝功能衰竭患者的肝功能和病毒学指标,ETV较LAM对HBV病毒抑制效果更为明显。
[Abstract]:Objective to compare the efficacy and safety of lamivudine and entecavir in the treatment of chronic hepatitis B complicated with chronic and acute hepatic failure. Methods Sixty-two patients with chronic hepatitis B and acute hepatic failure were randomly divided into lamivudine and lamivudine. Lam group (n = 31) and ETV group (n = 31). Lamivudine lamivudine 100 mg / g oral in lamivudine 100 mg / g / d / d in lamivudine group (ETV group) and entecavir treatment group (n = 31). Serum alanine amino-transfer was compared before and after treatment in the ETV group. Serum alanine amino transfer was compared between the two groups before and after treatment. The changes of ALT, Alb, Tbilirn, PTAA and virological indexes were observed. Results at 24 weeks after treatment, the survival rate of the LAM group was 77.4%, which was lower than that of the ETV group (87.1% / 31%). There was no significant difference between the two groups (P 0.05). The ALT and TBil of the two groups decreased significantly from 12 weeks to 24 weeks after treatment. Both P0.01Alb and P0.01Alb and PTA increased significantly (P0.05 or P0.01A), but there were significant differences between the two groups. There was no significant difference between the two groups (P 0.05). The MELD score and HBV DNA quantity in the two groups decreased significantly at 12 weeks and 24 weeks after treatment, and the MELD scores in the ETV group were lower than those in the LAM group and the HBV DNA negative rate in the LAM group was higher than that in the LAM group at 24 weeks after treatment. Conclusion both LAM and ETV can improve liver function and virology in patients with chronic hepatitis B and acute hepatic failure in a short period of time. ETV is more effective than LAM in inhibiting HBV virus.
【作者单位】： 广西桂东人民医院药学部;广西桂东人民医院感染性疾病科;
【基金】：中国高校医学期刊临床专项资金(No:11524324)
【分类号】：R512.62;R575.3
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