摘要目的 了解拉米夫定抗病毒治疗对失代偿性乙型肝炎肝硬化患者生存率的影响.方法 对60例接受拉米夫定抗病毒治疗的失代偿性肝硬化患者随防3年,并与102例未接受抗病毒治疗的历史对照组进行比较,应用Kaplan-Meier法分析治疗组与对照组患者生存率的改变情况.结果治疗组患者Child基础评分为9.4±2.4,治疗后12、24和36个月的Child评分分别为8.3±1.8、6.5±2.2和6.3±0.7,与对照组比较差异有统计学意义(P<0.01).随访中,治疗组患者有20例出现不同程度临床症状改善,而对照组没有类似改变.治疗6、12、24和36个月后,HBV DNA转阴率分别为84.7%(50/59)、89.2%(50/56)、76.8%(40/52)和72%(36/50);12、24和36个月YMDD变异率分别为0、7%(4/56)、17.3%(9/52)及26%(13/50).治疗组1、2和3年的生存率分别为77.7%、50%和46.5%,而对照组分别为71.28%、45%和43.5%,两组生存率比较差异无统计学意义(P=0.12).结论 拉米夫定抗病毒治疗能有效改善失代偿性乙型肝炎肝硬化患者的肝功能.

abstractsObjective To evaluate the efficacy of long-term lamivudine therapy in patients with decompensated cirrhosis after HBV infection. Methods The clinical courses and outcomes of lamivudine therapy in 60 patients with decompensated cirrhosis were observed and the results were compared with those in historical control group who did not receive lamivudine therapy. Kaplan-Meier method was used to measure the survival rates of two groups. Results There was significant improvement of Child scores in the treatment group, which were 9.4±2.4 at the baseline and 8.3±1.8, 6.5±2.2, 6.3±0.7 at 12 months,24 months and 36 months of the therapy (P<0.01), respectively. Significant clinical improvements were observed in 20 patients in the treatment group, but no improvement was observed in the controls. The rates of serum HBV DNA clearance was 84.7% (50/59), 89.2% (50/56), 76.8% (40/52) and 72%(36/50) at 6 months, 12 months, 24 months and 36 months of the therapy. And the rates of YMDD mutant were 0, 7% (4/56), 17.3% (9/52) and 26% (13/50) at these time points. The survival rates for the treatment group were 77.7%, 50% and 46. 5% at 1 year, 2 year and 3 year, while those in the control group were 71.28%, 45% and 43.5%, the difference was of no statistical significance (P=0.12).Conclusion Lamivudine therapy can significantly improve the liver function in patients with decompensated cirrhosis, but it may not improve the survival of patients.