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目的比较恩替卡韦与阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化的临床疗效。方法选取攀枝花市第四人民医院2011年7月—2015年6月收治的乙型肝炎肝硬化患者206例,依照随机数字表法将所有患者分为研究组和对照组,各103例。研究组予以阿德福韦酯联合拉米夫定治疗,对照组予以恩替卡韦治疗。比较两组患者治疗后1个月、3个月、6个月、治疗结束的乙肝病毒基因(HBV-DNA)转阴率、治疗前后肝功能指标(血清丙氨酸氨基转移酶、清蛋白、总胆红素及凝血酶原活动度)及不良反应发生情况。结果两组患者治疗后1个月、3个月、6个月、治疗结束HBV-DNA转阴率比较,差异无统计学意义(P>0.05)。治疗前后两组患者血清丙氨酸氨基转移酶、清蛋白、总胆红素水平及凝血酶原活动度比较,差异无统计学意义(P>0.05);治疗后两组患者血清丙氨酸氨基转移酶、总胆红素水平低于治疗前,清蛋白水平、凝血酶原活动度高于治疗前(P<0.05)。两组患者均未发生严重不良反应。结论恩替卡韦与阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化的临床疗效相当,均能较好地修复患者肝功能,但具体方案需结合临床综合考量。
Objective To compare the clinical efficacy of entecavir and adefovir dipivoxil combined with lamivudine in the treatment of hepatitis B cirrhosis. Methods Totally 206 patients with hepatitis B cirrhosis admitted in No.4 People’s Hospital of Panzhihua from July 2011 to June 2015 were enrolled in this study. All patients were divided into study group and control group according to random number table. The study group was treated with adefovir dipivoxil combined with lamivudine, while the control group was treated with entecavir. The HBV-DNA negative rates of one month, three months and six months after treatment were compared between the two groups. The liver function indexes (serum alanine aminotransferase, albumin, Total bilirubin and prothrombin activity) and adverse reactions occurred. Results There was no significant difference in HBV-DNA negative rates at the end of treatment between 1 month, 3 months and 6 months after treatment (P> 0.05). Serum alanine aminotransferase, albumin, total bilirubin and prothrombin activity in two groups before and after treatment showed no significant difference (P> 0.05); after treatment, serum alanine amino Transferase, total bilirubin levels before treatment, albumin level, prothrombin activity was higher than before treatment (P <0.05). No serious adverse reactions occurred in both groups. Conclusion The clinical efficacy of entecavir and adefovir dipivoxil combined with lamivudine in the treatment of hepatitis B cirrhosis is quite good, both of which can well repair the liver function of patients. However, the specific protocol needs to be combined with clinical comprehensive consideration.