目的 观察失代偿期乙型肝炎肝硬化患者长期抗病毒治疗疗效.方法 将78例乙型肝炎肝硬化失代偿期患者随机分为治疗组46例、对照组32例,治疗组给予拉米夫定(100mg/d)、阿德福韦酯(10 mg/d)、替比夫定(600 mg/d)或恩替卡韦(0.5 mg/d)口服,同时予以保肝、支持及对症治疗；对照组仅给予常规保肝、对症及支持治疗.随访结束时比较2组治疗前后Child-Pugh分级的变化、血清肝功能指标、肝纤维化指标及临床结局.结果 治疗组丙氨酸转氨酶、天冬氨酸转氨酶和总胆红素均较治疗前下降,白蛋白及胆碱酯酶(CHE)较治疗前升高,对照组治疗后CHE水平下降(P均＜0.05).治疗组治疗后39例(84.78％) Child-Pugh分级下降,肝纤维化指标较治疗前下降(P均＜0.05).两组发生肝癌比例分别为2.17％和21.88％,比较差异有统计学意义(P＜0.05).结论 失代偿期乙型肝炎肝硬化患者通过长期抗病毒治疗可以改善肝功能,改善预后,降低肝癌发生机会,延缓肝移植需求.%Objective To study the efficacy of long-term antiviral therapy on patients with hepatitis B virus related de-compensated cirrhosis. Methods Totally 78 patients with HBV-related decompensaled cirrhosis were enrolled. 46 cases were theated with nucleos(t)ide(theat group) and routine treatments, the other 41 cases only received routine treatments (control group). Patients treated with nucleos(t)ide analogue respectively received lamivudine (100 mg/d), or adefovir (10 mg/d), or entecavir(0.5 mg/d). Serum biochemical markers, Child-Pugh grades and clinical outcomes were compared between two groups at the end of following up. Results After anti-virus treatment, ALT, AST and TBil decreased (all P<0.05), while Alb and cholinesterase(CHE)increased in the treatment group(all P<0.05), and Child-Pugh scores decreased in 46 patients. While in the control group, ALT, AST and TBil did not change significantly(P > 0.05), meanwhile the CHE decreased significantly than before (P < 0. 05). The incidence of HCC was lower in treatment group (2. l%)than that in the control group(15.6% )(P<0.05). Conclusions Anti-virus treatment can significantly improve biochemical status of liver functions in patients with HBV-related decompensated cirrhosis. The incidence of hepatocellular carcinoma may decline and the long-term prognosis can be improved.
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