拉米夫定与阿德福韦酯初始联合与单药优化治疗代偿期乙型肝炎肝硬化的疗效比较

发布时间：2018-05-01 16:30

本文选题：肝炎 + 乙型　；参考：《重庆医学》2017年29期

【摘要】：目的观察拉米夫定(LAM)与阿德福韦酯(ADV)初始联合与单药优化治疗代偿期乙型肝炎肝硬化的疗效,并分析抗病毒治疗早期应答的影响因素。方法选取2014年1月至2015年12月该院收治的乙型肝炎肝硬化患者158例,采用随机数字表法进行分组:联合组(81例)给予LAM初始联合ADV治疗;优化组(77例)初始单用LAM或ADV,至24周优化联合用药。比较两组的临床疗效,并分析抗病毒治疗24周完全应答的影响因素。结果治疗12周后,联合组乙型肝炎病毒(HBV)DNA载量下降水平高于优化组(P0.05),但两组HBV DNA转阴率比较差异无统计学意义(P0.05)。治疗24周后,联合组HBV DNA载量下降水平和转阴率及完全应答率均高于优化组,病毒学突破率低于优化组(P0.05)。治疗48周后,联合组HBV DNA载量下降水平和转阴率、乙型肝炎e抗原(HBeAg)转阴率及血清学转换率均明显高于优化组,血清透明质酸和α2巨球蛋白水平均低于优化组(P0.05);但两组丙氨酸氨基转移酶(ALT)复常率、完全应答率和病毒学突破率比较,差异均无统计学意义(P0.05)。多因素Logistic回归分析显示,抗病毒治疗24周完全应答与治疗前HBV DNA载量、HBeAg、治疗前ALT水平及初始治疗方案有关(P0.05)。分层分析结果显示,无论治疗前HBV DNA载量高或低,HBeAg表达阳性或阴性及治疗前ALT水平高或低,联合组治疗24周完全应答率均明显高于优化组(P0.05)。结论 LAM和ADV初始联合治疗代偿期乙型肝炎肝硬化可以降低病毒耐药性,提高早期应答率,具有更强的抗病毒能力,并能较好地改善肝功能,可能部分逆转肝硬化。
[Abstract]:Objective to observe the efficacy of lamivudine (lamivudine) combined with adefovir dipivoxil (ADV) in the treatment of compensatory hepatitis B cirrhosis and analyze the influencing factors of early response to antiviral therapy. Methods from January 2014 to December 2015, 158 patients with hepatitis B cirrhosis were randomly divided into two groups: the combined group (n = 81) was treated with LAM combined with ADV; In the optimization group, 77 patients were treated with LAM or ADV alone, and the combination was optimized for 24 weeks. To compare the clinical efficacy of the two groups and to analyze the factors affecting the complete response in 24 weeks after antiviral therapy. Results after 12 weeks of treatment, the HBV DNA DNA load in the combined group was higher than that in the optimized group (P 0.05), but there was no significant difference in the negative rate of HBV DNA between the two groups (P 0.05). After 24 weeks of treatment, the decrease of HBV DNA load, the negative rate and the complete response rate in the combined group were higher than those in the optimized group, and the virological breakthrough rate was lower than that in the optimized group (P 0.05). After 48 weeks of treatment, the levels of HBV DNA load and the rate of turning negative, the rate of serological conversion and the rate of serological conversion of HBV DNA in the combined group were significantly higher than those in the optimized group. The levels of serum hyaluronic acid and 伪 2 macroglobulin were lower than those of the optimized group (P 0.05), but there was no significant difference between the two groups in the recovery rate of alanine aminotransferase (alt), complete response rate and virology breakthrough rate. Multivariate Logistic regression analysis showed that the complete response at 24 weeks after antiviral therapy was related to HBV DNA load before treatment, ALT level before treatment and initial treatment regimen (P 0.05). The results of stratified analysis showed that the total response rate of the combined group was significantly higher than that of the optimized group at 24 weeks, regardless of the high or low HBV DNA load before treatment and the high or low ALT level before treatment. Conclusion the combination of LAM and ADV in the initial treatment of compensatory hepatitis B cirrhosis can reduce the drug resistance of hepatitis B, increase the early response rate, have stronger antiviral ability, and improve liver function, which may partially reverse the liver cirrhosis.
【作者单位】：四川省人民医院消化内科;
【基金】：四川省卫生厅基金资助项目(110184)
【分类号】：R512.62;R575.2

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