Comparison Of The Efficacies Of Lamivudine Combined With Adefovir Dipivoxil De Novo And Entecavir Alone In Patients With Hepatitis B Virus-related Decompensated Cirrhosis

Aims: To compare the efficacies and safety of lamivudine(LAM)combined withadefovir dipivoxil(ADV) de novo and entecavir(ETV) alone in treatment of patientswith hepatitis B virus(HBV)-related decompensated cirrhosis.Methods: A total of91HBV-related decompensated cirrhosis patients (Child-Pughscore≥7points) were randomly divided into combined treatment group (n=48) andmonotherapy group (n=43).In addition to the basic approaches includingsymptom-driven intervention and supporting thempy,combined treatment group weregiven LAM and ADV,monotherapy group were given ETV.Liver and kidney function,AFP,Serum HBV DNA,HBsAg,HBeAg,HBsAb,HBeAb,PT,US or CT or MRI scan ofliver and Child-Pugh score were tested before and after12,24,48weeks of the anti viraltreatmen respectively.Results: there were30patients in the lamivudine combined with adefovir dipivoxilde novo group finishing the follow-up for48weeks, there are33patients in theentecavir monotherapy group finishing the follow-up for48weeks. Liver function andChild-Turcotte-Pugh (CTP) score were were significantly improved in both groups after48weeks,there was signifieant difference between before and after treatment（p<0.05）,but there was no signifieant difference between two groups（p>0.05）. HBV DNA loadwere significantly lower after treatment of12,24,48weeks than that before treatment inboth groups. By week48, the HBV DNA negative rates in LAM combined with ADVde novo group was65.2%,the HBV DNA negative rates in ETV group was84.00%, there was no signifieant difference (P>0.05)．By week48, The HBeAg negative rates inLAM combined with ADV de novo group was30％, the HBV DNA negative rates inETV group was27.3％, the HBeAg negative rates in two group wre similar,there wasno significant difference (P>0.05).By week48, Viral breakthrough happened in2eases(6.7%) in LAM combined with ADV group and1eases(3.0%) in ETV monotherapygroup, while no viral resistance was observed in two groups. By week48,3patients(6.2%) died in combined treatment group,1patient died of liver cell cancer,1patientdied of esophageal and gastric variceal hemorrhage, another1patient died of hepaticencephalopathy.2patients(4.7%) died in ETV monotherapy group,1patients died ofhepatic encephalopathy,1patient died of esophageal and gastric variceal hemorrhage.By week48, two groups had no serious adverse reactions.Conclusions: Both of lamivudine combined with adefovir dipivoxil de novo andentecavir monotherapy can inhibit HBV replication obviously,improve liver function inpatients with hepatitis B virus-related decompensated cirrhosis. Patients had goodtolerance to the LAM combined with ADV de novo or ETV monotherapy.