摘要目的 观察阿德福韦酯联合拉米呋定治疗YMDD变异的失代偿期肝硬化的疗效和安全性.方法 将70例在拉米夫定治疗过程中出现YMDD变异的乙型肝炎失代偿期肝硬化患者随机分为阿德福韦酯联合拉米呋定(治疗组)35例和单用拉米呋定(对照组)35例;两组均在保肝、利胆等常规内科综合治疗基础上继续接受拉米夫定100 ms/d口服治疗,治疗组在上述基础上联合阿德福韦酯10 ms/d.分别观察两组ALT、Tbil、ALB、Child-Pugh评分、生化应答率和HBV-DNA应答率、药物不良反应.结果 治疗组治疗后肝功能和Child-Push评分均好于对照组(P均<0.05),生化学应答率、HBV-DNA应答率、HBV-DNA转阴率显著高于对照组(P均<0.05).结论 阿德福韦酯联合拉米呋定治疗YMDD变异的失代偿肝硬化患者可以较快出现血清病毒学应答,能改善肝功能,减缓病情发展.

abstractsObjective To evaluate the efficacy and safety of adefovir dipivoxil and lamivudine in treatment of decompensated liver cirrhosis with YMDD mutatim.Methods 70 patients of decompensated liver cirrhois with YM-DD motif mutation were divided into adefovir dipivoxil combined lamivudine(treatment group)35 cases and lamivudi-ne alone(control group)35 eases;The patients in both groups received routine therapy and continued to receive lami-vudine at a dose of 100mg daily,moreover,the patients in treatment group received adefovir dipivoxil at a dose of 10 mg daliy.The index of ALT,Tbil,ALB,Child-Pugh score,biochemical response rate,HBV-DNA response,and adverse drug reactions were observed in two groups.Results The index of liver function and Child-Pugh scores in treatment group after treatment were better than the control group(P all<0.05);The rates of biochemical response,HBV-DNA response,HBV-DNA negative conversion in treatment group after treatment were significantly higher than the control group(P all<0.05).Conclusion Adefovir dipivoxil and lamivudine has satisfied efficacy and safety in treatment of decompensated liver cirrhosis patients with YMDD motif mutation.