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拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化临床观察摘要】目的探讨拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化临床疗效。
方法选择失代偿期乙型肝炎肝硬化患者共70例，随机分为治疗组35例，对照组35例。
2组均给予甘草酸二铵、还原型谷胱甘肽等综合保肝治疗。
对照组加拉米夫定100mg，口服1次/日；治疗组加拉米夫定100mg，及阿德福韦酯10mg，口服1次/日；疗程均为1年。
结果 2组患者在HBV-DNA水平下降，肝功能改善，凝血酶原活动度及Child-pugh积分等方面与治疗前比较，有统计学意义；2组治疗后比较，在HBV－DNA下降程度及病毒耐药方面有统计学意义。
结论拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者，疗效好，不易耐药，适合长期应用。
【关键词】拉米夫定阿德福韦酯慢性乙型肝炎失代偿期乙型肝炎肝硬化【Objective】To investigate the treatment of adefovirdipivoxil combined with lamivudine indecompensated cirrhosis clinical efficacy. Methods Patients withdecompensated cirrhosis were 70 cases, 35 cases were randomlydivided into treatmentgroup and controlgroup 35 cases. 2groups were allgivenglycyrrhizic aciddiammonium, liverglutathione and other comprehensive treatment. The controlgroup plus lamivudine 100mg, oral administration of 1 times /day; treatmentgroup plus lamivudine 100mg, and adefovirdipivoxil 10mg, oral administration of 1 times /day; a course of 1 year. Results 2 patients in thehBV-DNA levelsdecreased, liver function improved, and prothrombin activity, etc. Child-pugh points compared with before treatment, there was significant; 2groups after treatment,decrease inhBV-DNA level and there was significant resistance to the virus. Conclusions Lamivudine and adefovirdipivoxil in patients withdecompensated cirrhosis, efficacy, and not resistance, suitable for long-term use.【Key words】Iamivudine Adefovirdipivoxil Chronichepatitis B decompensated cirrhosis目前对慢性乙型肝炎及乙肝肝硬化患者进行抗病毒治疗，已形成共识，且取得了良好的效果。
阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿期的疗效及安全性研究目的：观察联合使用阿德福韦酯与拉米夫定抗病毒治疗乙型肝炎肝硬化失代偿期患者的安全性及疗效，从而找到更有效更安全的治疗方法。
方法：将120例HBV-DNA阳性肝硬化失代偿期患者随机分为联合用药组和单独用药组，在保肝、利尿、支持等基础治疗的同时，联合用药组服用阿德福韦酯及拉米夫定，单独用药组服用拉米夫定。
观察期为96周，观察两组患者的肝功能、肾功能、出凝血时间、HBV-DNA定量的变化。
结果：肝功能、出凝血时间均明显改善，HBV-DNA定量显著下降，而联合用药组在肝脏生化指标改善及存活率方面均优于单独用药组，差异有统计学意义（P＜0.01）。
两组均未发现严重的不良反应。
结论：阿德福韦酯、拉米夫定联合应用在治疗乙肝肝硬化失代偿期的患者时发挥优势互补作用，能迅速控制病情，改善生化指标，降低病毒载量，不宜产生耐药性，患者可以长期而安全地服用。
[Abstract] Objective: To observe the combination of adefovir dipivoxil and lamivudine to the patients with hepatitis B in decompensation of liver cirrhosis (LC), in order to get the data of safety and effects, so that the more effective and reliable therapy can be obtained. Methods: One hundred and twenty cases in the decompensation of LC with HBV-DNA were divided into two groups randomly. Under the same basic supporting therapy of diuretic and liver-protecting, one group was given the drug combination of adefovir dipivoxil and lamivudine, and the other was given lamivudine singly. In the 96 weeks of observation, got the data of hepatic function, renal function, bleeding-time and clotting-time, and HBV-DNA quantification of both groups. Results: For both, improvements could be seen in the hepatic function and bleeding-time and clotting-time, while the HBV-DNA quantification got lower. The group with drug combination performs was better than the other one with lamivudine in the aspects of hepatic biochemistry and survival rate, and there was difference (P＜0.01). Severe adverse reaction did not occur in both groups. Conclusion: The drug combination of adefovir dipivoxil and lamivudine to the patients with hepatitis B in decompensation of liver cirrhosis (LC) has superior and complementary effect. It can quickly control the condition, improve the biochemistry indicator, and decrease the viruses without getting drug resistance easily; as a result, the patients can have it safely in the long course of treatment.[Key words] Adefovir dipivoxil; Lamivudine; Anti-virus therapy; Decompensation of liver cirrhosis (LC)自1966年發现乙肝病毒（HBV）以来，乙型肝炎已成为世界上主要的公共健康问题之一。
拉米夫定联合阿德福韦酯治疗乙型肝炎失代偿期肝硬化临床疗效观察目的探究拉米夫定与阿德福韦酯联合治疗乙型肝炎失代偿期肝硬化的疗效观察。
方法随机选取笔者所在医院收治的乙型肝炎肝硬化患者60例，并平均将其随机分成实验组和对照组，两组均给予常规保肝、支持治疗。
实验组在以上基础上采用采用拉米夫定与阿德福韦酯联合对照组在保肝治疗基础上单用拉米夫定治疗。
结果两组患者治疗后各项生化指标，ALT 、TBiL 、ALB、肝功能Child-Pugh积分、HBV-DNA等均明显优于治疗前（P＜0.05）；但在治疗后实验组以上指标和总有效率均明显优于对照组（P＜0.05）。
结论拉米夫定与阿德福韦酯联合治疗乙型肝炎失代偿期肝硬化可以明显改善患者肝功能相关指标，改善患者的预后。
标签：拉米夫定；阿德福韦酯；乙型肝炎失代偿期肝硬化乙型肝炎后肝硬化是乙型肝炎病毒（HBV）持续在体内复制导致活动性肝炎反复发作，最终发展成为肝硬化，是乙肝的终末期病变。
对乙肝的治疗原则是采取有效措施有效抑制HBV的不断复制，避免或者减缓肝硬化的发生和发展[1]。
目前常用的药物是干扰素和核苷酸类似物，但许多研究报道核苷酸类似物长期使用可使病毒产生耐药性，患者复发率高。
本研究通过对失代偿期乙型肝炎肝硬化采用拉米夫定与阿德福韦酯联合治疗，取得良好的治疗效果，现将结果报道如下。
1资料与方法1.1一般资料随机选取笔者所在医院2009年3月～2010年10月收治失代偿期乙型肝炎肝硬化患者共60例，其中男42例，女18例。
诊断标准符合《病毒性肝炎防治方案》中的诊断标准[2]，将其随机分为实验组和对照组两组，实验组患者共30例，其中男21例，女9例，年龄34～73岁，平均（47.4±11.2）岁；病程7～14年，平均（10.5±4.3）年。
对照组患者共30例，其中男21例，女9例；年龄35～71岁，平均（46.9±10.8）岁，病程6～14年，平均（9.2±5.3）年。
拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化临床疗效观察目的：观察拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化患者的临床疗效。
方法：53例失代偿期乙型肝炎肝硬化患者在保肝、利尿和补充白蛋白等基础治疗的同时，给予拉米夫定100 mg，1次/d口服，3个月后，加用阿德福韦酯10 mg，1次/d口服，疗程48周。
治疗结束时，观察血清ALT、HBV DNA及Child-Pugh 评分变化。
结果：治疗后HBV DNA阴转率为90.2%，肝功能指标即血清ALT 水平及Child-Pugh评分明显改善。
结论：拉米夫定联合阿德福韦酯治疗能明显改善乙型肝炎肝硬化患者的肝功能指标，不易产生耐药性，改善预后。
[Abstract] Objective: To evaluate the clinical efficacy of Lamivudine and Adefovir treatment in patients with decompensated liver cirrhosis resulting from hepatitis B. Methods: Fifty three patients with decompensated liver cirrhosis with hepatitis B were included with Lamivudine 100 mg and Adefovir 10 mg once daily for 48 weeks. Serum HBV DNA, hepatitis B serology markers, ALT level and Child-Pugh scores were measured after therapy. Results: The negative rate of HBV DNA was 90.2%. Liver function index including serum ALT level and the Child-Pugh scores improved obviously. Conclusion: Combination Lamivudine and Adefovir in treatment of decompensated liver cirrhosis resulting from hepatitis B has obvious effect on improving the liver function and outcomes.[Key words] Lamivudine; Adefovir; Hepatitis B; Cirrhosis; Decompensation失代偿期乙型肝炎肝硬化患者的5年生存率较低，并发症多、治疗困难，预后较差。
