摘要
目的:观察降肝隆联合拉米夫定治疗活动性肝炎肝硬变90例5a的长期疗效.方法:随机选择活动性肝炎肝硬变患者90例,分为治疗组和对照组.治疗组采用降肝隆煎剂和拉米夫定联合治疗;对照组采用退黄、降酶、抗纤维化、支持及对症处理;疗程6-67mo,疗程的中位数为31.4mo.对血清病毒水平、肝功能、合并症、肝癌的发生率、病死率进行观察.结果:HBVDNA阴转率:治疗组为61.4%(27/44),对照组为6.5%(3/46),两组比较,差异显著(P=0.0001);HBeAg转阴率:治疗组为33.3%(11/33),对照组为6.7%(2/30),两组比较,差异显著(P=0.0321);治疗组患者12,24,36,37-67mo,变异率分别为11.4%,22.7%,34.1%,38.6%.治疗组YMDD非变异病例的总胆红素(TBil)、Child-pugh分级积分下降,白蛋白(A)升高,与对照组相比,差异显著(17.90±1.01μmol/Lvs62.57±52.23μmol/L;5.18±1.40vs7.50±3.16;42.32±6.39g/Lvs38.35±7.27g/L,P<0.01);合并症的发生率:治疗组11.4%,对照组45.6%,两组比较,差异显著(P=0.007);肝癌的发生率,两组无显著差异(P=0.2998);死亡率:治疗组为9.1%,对照组为30.4%,两组比较,差异显著(P=0.0377).结论:降肝隆联合拉米夫定治疗活动性肝炎肝硬变,可抑制病毒复制,YMDD累计变异率较低,肝功能得到改善,减少了合并症的发生、降低了患者的病死率.
AIM： To investigate the long term effect of Traditional Chinese Medicine Xiangganlong combined with Lamivudine in the treatment of active hepatitis and cirrhosis. METHODS： The randomly selected 90 patients with active hepatitis and cirrhosis were divided into treatment group and control group. The patients in the former were treated with Xiangganlong combined with Lamivudine, the patients in the control group were treated with general treatment according to the symptoms. Six to sixty-seven months after treatment, the serum virus level, liver function, complications, the occurrence rate of hepatocellular carcinoma, and the mortality rate were analyzed. RESULTS： The negative rates of hepatitis B virus DNA in the patients of treatment group and control group were 61.4% （27/44） and 6.5% （3/46）, respectively, and there was significant difference between them （P = 0.000 1）. The negative rate of HBeAg was also markedly higher in the patients of treatment group than that in the controls [33.3% （11/33） vs 6.7% （2/30）, P = 0.032 1]. The variation rates of YMDD were 11.4%, 22.7%, 34.1%, 38.6% after 12, 24, 36, 37-67 mo of combined Lamivudine treatment, respectively. In the patients with no YMDD variation, the total bilirubin （TBiL） and Child-pugh score were significantly declined, while the level of albumin （A） was increased as compared with that in the controls （17.90±1.01 μmol/L vs 62.57±52.23 μmol/L, P 〈0.01; 5.18±1.40 vs 7.50±3.16, P 〈0.01; 42.32±6.39 g/L vs 38.35±7.27 g/L, P 〈0.01）. The occurrence rate of complications was 11.4% and 45.6% （P = 0.007） in the treatment and control group, respectively, while the occurrence rate of hepatocellular carcinoma was not significantly different between those two groups （P = 0.299 8）. The mortality was 9.1% and 30.4% （P = 0.037 7） in the treatment and control group, respectively. CONCLUSION： The Traditional Chinese Medicine Xiangganlong combined with Lamivudine can impress the proliferation of HBV, decrease the variation rates of YMDD, improve the hepatic function, reduce the occurrence of the complications and mortality.
出处
《世界华人消化杂志》
CAS
北大核心
2005年第20期2509-2513,共5页
World Chinese Journal of Digestology
