摘要
目的研究拉米夫定联合阿德福韦酯治疗乙型肝炎肝硬化失代偿期患者的疗效、YMDD变异和安全性。方法 61例乙型肝炎肝硬化失代偿期患者随机分为两组,A组28例予拉米夫定100mg/d;B组33例拉米夫定100mg/d联合阿德福韦酯10mg/d治疗。以上两组的疗程为96周。均给予常规护肝及支持、对症治疗。观察两组患者HBV DNA定量、Child-Pugh评分变化、YMDD变异及药物不良反应情况。结果两组患者治疗后均有明显的HBV DNA转阴率和Child-Pugh评分改善,但两组之间进行这两项比较时差异无统计学意义(P>0.05)。拉米夫定组治疗48周时发生YMDD变异,且随着时间延长,变异数增加,而联合治疗组未发生变异。72周后两组比较差异有统计学意义(P<0.05)。治疗中两组各有2例死亡,未发生与药物相关的严重不良反应。结论拉米夫定联合阿德福韦酯与单用拉米夫定治疗乙型肝炎肝硬化失代偿期患者96周的疗效与安全性均相似,但能显著减少YMDD变异的发生。二者联合是一种有效且理想的治疗乙型肝炎肝硬化失代偿期的方法。
Objective To observe the curative efficacy,YMDD mutation and safety of lamivudine combined with adefovir dipivoxil treated Hepatitis B patients with decompensated cirrhosis.Methods 61 patients from our hospital between March 2006 and June 2009,were randomLy divided into two groups.28 patients in group A were treated with lamivudine 100mg per day.And 33 patients in group B were treated with lamivudine 100mg and adefovir dipivoxil 10mg per day.They also received living-protecting,and the other symptomatic treatments.The total treatment in these two groups was 96 weeks.The level of HBV DNA,Child-Pugh score,YMDD mutation and adverse drug reactions were detected detailedly.Results After the treatment,there were obvious undetectable rate of HBV DNA and improved Child Pugh score in the two groups.But the comparisons have no statistical difference（P0.05）.YMDD mutation would appear at 48 weeks in group A which used lamivudine 100mg per day for treatment.The greater variation would come out as the time become longer.There were no YMDD mutation in group B at the total treatment.YMDD variation had significant differences between the two groups at 72 weeks（P0.05）.Two groups have two example deaths respectively,and no medicine related serious untoward effect occured.Conclusion Using lamivudine combined with adefovir dipivoxi therapy or lamivudine monotherapy to treat Hepatitis B patients with decompensate cirrhosis,the curative efficacy and safety are similar,but the combination therapy treatment can significantly reduce the incidence of YMDD mutation.Combination therapy is an effective and ideal treatment of hepatitis B decompensated cirrhosis.
出处
《中国医药指南》
2011年第23期12-14,共3页
Guide of China Medicine
关键词
肝硬化
失代偿
联合治疗
拉米夫定
阿德福韦酯
Cirrhosis
Decompensation
Combination therapy
Lamivudine
Adefovir dipivoxil
