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目的:分析替比夫定(LdT)联合阿德福韦酯(ADV)治疗经肝穿刺活检进行病理分级指导下的慢乙肝患者的临床疗效。方法:随机抽取2010年5月-2012年10月本院接诊的82例乙型肝炎e抗原(HBeAg)阳性(50例)或阴性(32例)患者作为研究对象,均为HBV-DNA定量≥1×104 copies/mL,经肝穿刺活检显示中~重度活动性炎症、坏死、和(或)纤维化的慢乙肝患者。给予替比夫定联合阿德福韦酯行抗病毒治疗。每3个月对患者进行HBV-DNA水平、肝功能、“两对半”定量检测,监测患者血常规、肾功能、AFP及心肌酶等指标,观察临床疗效及药物不良反应。结果:本组患者HBV-DNA水平明显下降,与治疗比较差异显著(P<0.05);有28例患者HBeAg滴度出现不同程度下降,差异无统计学意义(P>0.05);所有患者检查血常规、肾功能、AFP无异常改变。结论:LdT+ADV联合抗病毒治疗,对经肝活检证实病理组织学分级≥G2和(或)S1~2慢乙肝患者,有明显抑制HBV-DNA复制水平的作用。有预期的提高HBeAg-抗-HBe血清学转换率、减少抗病毒治疗疗程,达到缩短口服药物抗病毒治疗疗程的可能。
OBJECTIVE: To analyze the clinical efficacy of telbivudine (LdT) and adefovir dipivoxil (ADV) in the treatment of chronic hepatitis B patients undergoing liver biopsy under pathological grading. Methods: 82 cases of HBeAg-positive (50 cases) or negative (32 cases) patients admitted to our hospital from May 2010 to October 2012 were randomly selected for the study, and all were HBV-DNA quantitative ≥1 × 104 copies / mL, liver biopsy showed moderate to severe active inflammation, necrosis, and (or) fibrosis in patients with chronic hepatitis B. Give telbivudine plus adefovir dipivoxil antiviral therapy. The level of HBV-DNA, liver function and “two and a half” of the patients were measured quantitatively every 3 months. The blood routine, renal function, AFP and myocardial enzymes were monitored to observe the clinical curative effect and adverse drug reaction. Results: The level of HBV-DNA in this group was significantly lower than that in the treatment group (P <0.05); HBeAg titers in 28 patients decreased to some extent (P> 0.05); all patients had blood tests Routine, renal function, AFP no abnormal changes. Conclusion: LdT + ADV combined with antiviral therapy can significantly inhibit HBV-DNA replication in patients with pathological histological grading ≥G2 and / or S1 ~ 2 chronic hepatitis B confirmed by liver biopsy. It is expected to increase the seroconversion rate of HBeAg-anti-HBe and reduce the course of antiviral therapy to shorten the course of oral antiviral therapy.