本文選題：e抗原陰性 + 肝硬化失代償��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景：失代償期肝硬化屬晚期肝病,具有并發(fā)癥多、治療困難等特點。據(jù)相關(guān)報道,肝硬化失代償期5年的生存率只有14%,因此失代償期肝硬化患者的治療尤為重要,其根本為抗病毒治療。 目的：觀察初始拉米夫定(LAM)聯(lián)合阿德福韋酯(ADV)對e抗原陰性乙型肝炎失代償期肝硬化患者的治療效果及安全性；對比單用阿德福韋酯和單用拉米夫定對這類患者的治療效果；初步探討初始聯(lián)合治療(LAM+ADV)降低乙肝病毒耐藥性的原理及效果。 方法：研究南陽市中心醫(yī)院感染科收治的e抗原陰性乙型肝炎失代償期肝硬化患者共200例,隨機分為聯(lián)合治療組(LAM+ADV組)80例、單藥治療組共120例：其中拉米夫定單藥組(LAM組)60例、阿德福韋酯單藥組(ADV組)60例。LAM+ADV組給予LAM100mg/d+ADV10mg/d,LAM組給予LAM100mg/d,ADV組給予ADV10mg/d。各組的保肝治療方案相同。觀察比較各組患者在治療前及治療后12周、24周和48周血清HBV DNA水平；治療前及治療后2周、4周、6周和8周肝功能轉(zhuǎn)歸以及Child-Pugh評估,同時觀察臨床癥狀改善情況及藥物的不良反應(yīng)。 結(jié)果：統(tǒng)計分析治療12周、24周和48周聯(lián)合治療組和各單藥組病毒學(xué)應(yīng)答情況：在治療12周時LAM+ADV組HBV DNA陰轉(zhuǎn)率尤為突出,即LAM+ADV組的HBV DNA陰轉(zhuǎn)率達到95%,而LAM組和ADV組的HBV DNA陰轉(zhuǎn)率分別為83.3%和66.7%,具有顯著差異(P0.05)；在治療12周和24周時,LAM組HBV DNA陰轉(zhuǎn)率(83.3%、90%)都高于ADV組(66.7%、80%),具有顯著差異(P0.05)；在治療48周時LAM+ADV組、LAM組及ADV組HBV DNA陰轉(zhuǎn)率分別為97.5%、83.3%和80%,聯(lián)合治療組與各單藥組均具有顯著性差異(P0.05); LAM組HBV DNA陰轉(zhuǎn)率(83.3%)與ADV組HBV DNA陰轉(zhuǎn)率(80%)無差異(P0.05)。各治療組患者HBV DNA陰轉(zhuǎn)率隨著時間的延長也有所提高,治療24周后HBV DNA陰轉(zhuǎn)率不再增加。研究還發(fā)現(xiàn)LAM+ADV組與LAM組、ADV組在治療48周后HBV DNA陰轉(zhuǎn)率均未達100%。統(tǒng)計分析在治療2、4、6和8周時肝功能主要指標(biāo)以及Child-Pugh評分情況：各個治療組在治療8周以后的ALT、AST、TBiL和ALB均有明顯改善,與治療前相比差異具有統(tǒng)計學(xué)意義(P0.05); LAM+ADV組在第6周時肝功能已基本復(fù)常,而LAM組、ADV組均在第8周時才有明顯改善,LAM+ADV組優(yōu)于LAM組及ADV組；8周時LAM+ADV組、LAM組和ADV組Child-Pugh評估分別為6.8±1.0、7.1±1.3和7.3±1.2,與各組治療前相比差異均有統(tǒng)計學(xué)意義(P0.05)。三組均未見明顯的不良反應(yīng),無腎功能異常。 結(jié)論：對e抗原陰性乙型肝炎失代償期肝硬化患者,初始拉米夫定聯(lián)合阿德福韋酯的治療效果優(yōu)于單用拉米夫定或阿德福韋酯治療效果。
[Abstract]:Background: decompensated cirrhosis is a late liver disease with many complications and difficulties in treatment. According to relevant reports, the 5-year survival rate of decompensated cirrhosis is only 14%, so the treatment of decompensated cirrhosis is particularly important, which is basically antiviral therapy. Objective: to observe the efficacy and safety of lamivudine combined with adefovir dipivoxil (ADV) in the treatment of hepatitis B patients with decompensated liver cirrhosis with negative e antigen, and to compare the efficacy of adefovir alone and lamivudine alone in the treatment of these patients. To explore the principle and effect of initial combined therapy with laminar ADV (Lam ADV) in reducing drug resistance of hepatitis B virus (HBV). Methods: a total of 200 patients with liver cirrhosis in decompensated phase of hepatitis B with negative e antigen were randomly divided into two groups: the combined treatment group (n = 80) and Lam ADV group (n = 80). There were 120 cases in single drug treatment group: 60 cases in lamivudine group with lamivudine group and 60 cases in single drug group with adefovir dipivoxil group. 60 cases in lamivudine group were given 100 mg / d ADV10 mg / d of LAM100 mg / d ADV10 mg / d in lamivudine group. The liver protection regimen was the same in each group. The serum HBV DNA levels were observed and compared before treatment and 12 weeks and 48 weeks after treatment, liver function and Child-Pugh were evaluated before treatment and 2 weeks after treatment, 6 weeks and 8 weeks after treatment, and before treatment and 2 weeks after treatment, the changes of liver function and Child-Pugh were evaluated. At the same time, the improvement of clinical symptoms and adverse drug reactions were observed. Results: the virological responses of the combined treatment group and each single drug group at 12 weeks and 48 weeks after treatment were statistically analyzed. The HBV DNA negative conversion rate in LamADV group was particularly significant at 12 weeks after treatment. That is to say, the HBV DNA negative conversion rate of LamADV group was 95, while the HBV DNA negative conversion rate of Lam group and ADV group was 83.3% and 66.7%, respectively, with significant difference (P0.05), and the HBV DNA negative conversion rate of LAM group was 83.390 at 12 weeks and 24 weeks after treatment, which was significantly higher than that of ADV group (66.70.80%). At 48 weeks after treatment, the negative conversion rates of HBV DNA in Lam ADV group and ADV group were 97.53.3% and 80%, respectively. There was significant difference between the combined treatment group and the single drug group (P 0.05), but there was no significant difference between the Lam group and the ADV group (83.3%) and the ADV group (80%). The negative conversion rate of HBV DNA in all treatment groups was also increased with the prolongation of time, and the negative conversion rate of HBV DNA did not increase after 24 weeks of treatment. It was also found that the negative rate of HBV DNA in both LAMADV and Lamb ADV groups did not reach 100% 48 weeks after treatment. The main indexes of liver function and Child-Pugh score at 2 weeks and 8 weeks after treatment were statistically analyzed. Compared with before treatment, the difference was statistically significant (P 0.05), the liver function in LamADV group had basically returned to normal at the 6th week, but the improvement of Lamm ADV group was better than that of Lam ADV group and ADV group at the 8th week. At 8 weeks, the Child-Pugh assessment of laminar group and ADV group were 6.8 鹵1.0 鹵7.1 鹵1.3 and 7.3 鹵1.2, respectively, which were significantly different from those before treatment (P 0.05). There were no obvious adverse reactions and no abnormal renal function in the three groups. Conclusion: the efficacy of lamivudine combined with adefovir in the treatment of hepatitis B patients with decompensated cirrhosis is better than that of lamivudine or adefovir alone.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62;R575.2

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