- 作者：Spilios Manolakopoulos ; Christos Triantos ; Jiannis Theodoropoulos ; Jiannis Vlachogiannakos ; Anastasios Kougioumtzan ; George Papatheodoridis ; Dimitrios Tzourmakliotis ; Dimitrios Karamanolis ; Andrew K.
- 关键词：Lamivudine ; Portal pressure ; Hepatitis B DNA ; Prognosis
- 刊名：Journal of Hepatology
- 出版年：2009
- 出版时间：September 2009
- 年：2009
- 卷：51
- 期：3
- 页码：468-474
- 全文大小：198 K
Background/Aims
Lamivudine improves liver histology in patients with chronic hepatitis B (CHB), but its effects on portal pressure remain unknown. We evaluated the effect of lamivudine monotherapy on hepatic venous pressure gradient (HVPG) in CHB-related cirrhosis with significant portal hypertension.Methods
We studied 19 patients with cirrhosis due to HBeAg-negative CHB and HVPG 10 mm Hg treated with oral lamivudine (100 mg daily). Liver biochemistry, Child-Pugh and MELD score were determined every 3 months, alpha-fetoprotein and HBV DNA every 6 months and HVPG at baseline and at 12 months after lamivudine initiation. Diuretics, beta-blockers, antibiotics and/or endoscopic therapy were used for routine indications.
Results
At 12 months, a significant reduction was observed in ALT (p = 0.001), HBV DNA (p = 0.002), Child-Pugh (p = 0.012) and MELD score (p = 0.006). Four patients developed virological breakthrough during treatment. At 12 months, HVPG decreased in all but one patient [baseline: 14.4 ± 3.9 and 12 months: 12.4 ± 3.3 mm Hg (p = 0.007)]. HVPG decreased >20 % or below the 12 mm Hg threshold in 10 of 13 patients with baseline HVPG 12 mm Hg. HVPG increased in a patient with hepatic flare after virological breakthrough.
Conclusion
In conclusion, in patients with cirrhosis due to HBeAg-negative CHB, lamivudine monotherapy reduces HVPG, especially when virological suppression and biochemical remission is achieved.