阿德福韦酯联合拉米夫定治疗乙肝肝硬化的临床疗效观察
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摘要
目的对阿德福韦酯联合拉米夫定治疗乙肝肝硬化的临床疗效进行观察和分析。方法选取2013年1~8月住院治疗的活动性代偿期乙肝肝硬化患者100例为研究对象,根据用药方法不同随机分为观察组与对照组,每组50例,两组均予以改善肝功能、抗纤维化、降酶、纠正水和电解质及酸碱平衡、给予营养等对症支持治疗;对照组予拉米夫定100 mg,1次/d,观察组同时予阿德福韦酯10 mg,1次/d,两组均连用12个月。观察并比较两组患者的临床疗效及两组患者治疗前后谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清白蛋白(ALB)、总胆红素(TBII)及肝脏Child-Pugh评分的变化情况、两组患者治疗前后Child-Pugh分级评分。结果观察组的总有效率为92.00%,对照组的总有效率为70.00%,两组疗效比较,差异存在统计学意义(92.00%vs 70.00%,P<0.05)。观察组与对照组治疗后的Child-Pugh分级评分分别较治疗前显著降低,且观察组的Child-Pugh分级评分显著低于对照组(P<0.05)。观察组与对照组治疗后的ALT、AST、IBIL分别较治疗前显著降低,两组ALB水平治疗后分别较治疗前显著升高,且观察组治疗后的ALT、AST、TBIL及ALB水平较对照组改善更显著(P<0.05)。结论阿德福韦酯联合拉米夫定治疗乙肝肝硬化可以提高疗效,改善患者的肝功能及临床症状,值得推广和应用。
Objective The clinical curative effect of adefovir and lamivudine in treatment of hepatitis B cirrhosis observation and analysis.Methods 100 patients with active hepatitis B related cirrhosis who were hospitalized from January2013 to August were selected.According to different methods of treatment they were randomly divided into the observation group and control group,50 cases in each,two groups were under improvement of liver function,anti fibrosis,reducing enzyme,correct water,electrolyte and acid-base balance,giving nutrition symptomatic and supportive treatment;patients in control group were treated with lamivudine 100 mg /d,and the observation group also received the therapy of adefovir dipivoxil 10mg/d,two groups used in conjunction for 12 months.The clinical curative effect of the two groups,and ALT,AST,TBIL,ALB,Child-Pugh score in two groups before and after treatment were compared.Results The total effective rate of the observation group was 92.00%,and the total effective rate was 70.00%in the control group,the difference was significant(92.00%vs 70.00%,P<0.05).After treatment,the Child-Pugh scores of the observation group and the control group were significantly lower than before treatment,and the Child-Pugh score of the observation group was significantly lower than that in the control group,the difference was significant(P<0.05).After treatment,ALT,AST,TBIL and ALB levels were significantly lower than those in the control group,while the ALT,AST,TBIL and ALB levels in the observation group were significantly higher than before treatment(P<0.05).The difference was significant(P<0.05).Conclusion Adefovir dipivoxil combined with lamivudine in the treatment of hepatitis B related cirrhosis can improve the curative effect,improve liver function and clinical symptoms of the patients,and worthy of promotion and application.
Objective The clinical curative effect of adefovir and lamivudine in treatment of hepatitis B cirrhosis observation and analysis.Methods 100 patients with active hepatitis B related cirrhosis who were hospitalized from January2013 to August were selected.According to different methods of treatment they were randomly divided into the observation group and control group,50 cases in each,two groups were under improvement of liver function,anti fibrosis,reducing enzyme,correct water,electrolyte and acid-base balance,giving nutrition symptomatic and supportive treatment;patients in control group were treated with lamivudine 100 mg /d,and the observation group also received the therapy of adefovir dipivoxil 10mg/d,two groups used in conjunction for 12 months.The clinical curative effect of the two groups,and ALT,AST,TBIL,ALB,Child-Pugh score in two groups before and after treatment were compared.Results The total effective rate of the observation group was 92.00%,and the total effective rate was 70.00%in the control group,the difference was significant(92.00%vs 70.00%,P<0.05).After treatment,the Child-Pugh scores of the observation group and the control group were significantly lower than before treatment,and the Child-Pugh score of the observation group was significantly lower than that in the control group,the difference was significant(P<0.05).After treatment,ALT,AST,TBIL and ALB levels were significantly lower than those in the control group,while the ALT,AST,TBIL and ALB levels in the observation group were significantly higher than before treatment(P<0.05).The difference was significant(P<0.05).Conclusion Adefovir dipivoxil combined with lamivudine in the treatment of hepatitis B related cirrhosis can improve the curative effect,improve liver function and clinical symptoms of the patients,and worthy of promotion and application.
引文
[1]连晓明,覃舒扬,莫金荣.阿德福韦酯联合拉米夫定与恩替卡韦单药治疗乙肝肝硬化疗效比较[J].海南医学。2013,24(22):3303-3304.
[2]肖扬,郑金莉,周岳进,等.拉米夫定或阿德福韦酯选择性治疗失代偿性乙型肝炎肝硬化3年临床观察[J].肝脏,2010,15(12):111-112.
[3]王往.阿德福韦酯联合拉米夫定治疗乙肝肝硬化失代偿期的疗效观察[J].右江医学,2014,42(1):54-55.
[4]张志琴,李冥珊.阿德福韦酯与其他药物联合治疗乙肝研究进展[JJ.海峡药学,2012,24(8):106-108.
[5]李云静.阿德福韦酯联合拉米夫定治疗乙肝肝硬化失代偿期的疗效及安全性评价[J].实用药物与临床,2012,15(12):822-824.
[6]张勇刚,杨利,董明珍,等.阿德福韦酯联合胸腺肽α1治疗对拉米夫定无应答的HBeAg阴性慢性乙型肝炎疗效观察[J].中国医药,2011,6(3):295-296.
[7]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].胃肠病学,2011,16(6):351-366.
[8]李文刚,聂为民,何艳梅,等.拉米夫定联合阿德福韦酯治疗活动性乙肝肝硬化长期疗效观察[J].山东医药,2011,51(36):48-81.
[9]李自莠.拉米夫定联合阿德福韦酯对活动性乙肝肝硬化长期治疗的疗效[J].中外医疗,2013,15(8):112-113.
[10]叶晓丽.拉米夫定联合阿德福韦酯治疗45例乙肝肝硬化的临床疗效分析[J1.北方药学,2014,11(1):43-44.
[11]周翠.阿德福韦酯联合拉米夫定治疗肝硬化失代偿期的近期疗效观察[J].中国社区医师(医学专业),2010,17(5):169-171.
[12]邱源旺,蒋祥虎,黄利华,等.阿德福韦酯联合拉米夫定治疗YMDD变异的慢性乙型肝炎疗效相关因素分析[J].实用肝脏病杂志,2009,19(5):129-131.
[13]周先珊,万谟彬,郑瑞英.阿德福韦酯单药或联合拉米夫定治疗耐药慢性乙型肝炎患者的临床研究[J].解放军医学杂志,2009,14(2):128-129.
[14]廖绍筑,陈少兴,汤净.阿德福韦酯和拉米夫定治疗乙型肝炎肝硬化的疗效比较[J].实用医学杂志,2010,26(1):114-115.
[15]邬振国.拉米夫定治疗慢性乙型肝炎的随机对照研究[J].海南医学,2011,22(21):30-32.
[16]李思潮,韩常新,邢陆.阿德福韦酯和恩替卡韦治疗乙肝肝硬化48周疗效对比研究[J].中国冶金工二业医学杂志,2014.31(4):395-396.
[17]姚玲娣.阿德福韦酯治疗活动性代偿期乙肝肝硬化疗效观察[J].广东医学,2009,30(10):1558-1559.
[18]赵兴忠,吴杭源.阿德福韦酯治疗YMDD变异的乙肝肝硬化患者疗效观察[J].右江医学,2007,35(4):377-378.
[19]桂亚萍.阿德福韦酯片治疗活动性代偿期乙肝肝硬化的临床效果[J].中国中医药咨讯,2012,4(5):210.
[20]李晶晶,汪雪芬.慢性乙肝肝硬化应用拉米夫定联合阿德福韦酯治疗的疗效探究[J].医学理论与实践,2015,28(8):1050-1051.
[21]李勇.拉米夫定联合阿德福韦酯治疗活动性乙肝肝硬化的长期临床效果观察[J].中国医药指南,2013,11(34):129-130.
[22]蓝晓琳,葛宇黎.拉米夫定短期联合阿德福韦酯治疗代偿期乙肝肝硬化疗效观察[J].海峡药学,2011,23(1):73-74.
[2]肖扬,郑金莉,周岳进,等.拉米夫定或阿德福韦酯选择性治疗失代偿性乙型肝炎肝硬化3年临床观察[J].肝脏,2010,15(12):111-112.
[3]王往.阿德福韦酯联合拉米夫定治疗乙肝肝硬化失代偿期的疗效观察[J].右江医学,2014,42(1):54-55.
[4]张志琴,李冥珊.阿德福韦酯与其他药物联合治疗乙肝研究进展[JJ.海峡药学,2012,24(8):106-108.
[5]李云静.阿德福韦酯联合拉米夫定治疗乙肝肝硬化失代偿期的疗效及安全性评价[J].实用药物与临床,2012,15(12):822-824.
[6]张勇刚,杨利,董明珍,等.阿德福韦酯联合胸腺肽α1治疗对拉米夫定无应答的HBeAg阴性慢性乙型肝炎疗效观察[J].中国医药,2011,6(3):295-296.
[7]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].胃肠病学,2011,16(6):351-366.
[8]李文刚,聂为民,何艳梅,等.拉米夫定联合阿德福韦酯治疗活动性乙肝肝硬化长期疗效观察[J].山东医药,2011,51(36):48-81.
[9]李自莠.拉米夫定联合阿德福韦酯对活动性乙肝肝硬化长期治疗的疗效[J].中外医疗,2013,15(8):112-113.
[10]叶晓丽.拉米夫定联合阿德福韦酯治疗45例乙肝肝硬化的临床疗效分析[J1.北方药学,2014,11(1):43-44.
[11]周翠.阿德福韦酯联合拉米夫定治疗肝硬化失代偿期的近期疗效观察[J].中国社区医师(医学专业),2010,17(5):169-171.
[12]邱源旺,蒋祥虎,黄利华,等.阿德福韦酯联合拉米夫定治疗YMDD变异的慢性乙型肝炎疗效相关因素分析[J].实用肝脏病杂志,2009,19(5):129-131.
[13]周先珊,万谟彬,郑瑞英.阿德福韦酯单药或联合拉米夫定治疗耐药慢性乙型肝炎患者的临床研究[J].解放军医学杂志,2009,14(2):128-129.
[14]廖绍筑,陈少兴,汤净.阿德福韦酯和拉米夫定治疗乙型肝炎肝硬化的疗效比较[J].实用医学杂志,2010,26(1):114-115.
[15]邬振国.拉米夫定治疗慢性乙型肝炎的随机对照研究[J].海南医学,2011,22(21):30-32.
[16]李思潮,韩常新,邢陆.阿德福韦酯和恩替卡韦治疗乙肝肝硬化48周疗效对比研究[J].中国冶金工二业医学杂志,2014.31(4):395-396.
[17]姚玲娣.阿德福韦酯治疗活动性代偿期乙肝肝硬化疗效观察[J].广东医学,2009,30(10):1558-1559.
[18]赵兴忠,吴杭源.阿德福韦酯治疗YMDD变异的乙肝肝硬化患者疗效观察[J].右江医学,2007,35(4):377-378.
[19]桂亚萍.阿德福韦酯片治疗活动性代偿期乙肝肝硬化的临床效果[J].中国中医药咨讯,2012,4(5):210.
[20]李晶晶,汪雪芬.慢性乙肝肝硬化应用拉米夫定联合阿德福韦酯治疗的疗效探究[J].医学理论与实践,2015,28(8):1050-1051.
[21]李勇.拉米夫定联合阿德福韦酯治疗活动性乙肝肝硬化的长期临床效果观察[J].中国医药指南,2013,11(34):129-130.
[22]蓝晓琳,葛宇黎.拉米夫定短期联合阿德福韦酯治疗代偿期乙肝肝硬化疗效观察[J].海峡药学,2011,23(1):73-74.