The Effect Of Lamivudine Application For HBV-velated Decompensated Cirrhosis

Decompensated liver cirrhosis is the common and serious outcome of chronic hepatitis B (HBV) infection. Liver transplantation is generally regarded as a valid treatment of choice for decompensated liver cirrhosis. However in China,only a small proportion of patients have the opportunity to receive liver transplantation as the amout of donors is limited. So it is important to find effective medicament for most of the other patients. Ongoing HBV replication and expression of viral antigens at the liver cell surface are certainly important determinants for the pathogenesis of HBV-associated liver diseases. Antiviral therapy plays a major role in the treatment of HB V-related decompensated liver cirrhosis.Lamivudine has been applied to the treatment of HBV-related decompensated liver cirrhosis for its proven efficacy and security in chronic hepatitis B infection. Results of clinical trials showed that lamivudine can decrease complications,improve life quality and reduce mortality rate of HBV-related decompensated liver cirrhosis patients. However,all the trials were the self-controlled studies and most of the patients were after liver transplantation. So the results were not convincible as they were inevitablly influenced by other factors including sample size,choice of patients,etc.In our study,21 HBV-related decompensated liver cirrhosis patients without liver transplantation have been followed-up for 3 years in a control study. The liver function parameters,virology data,Child-Pugh-Turcotte Score (CPT),complications and morality rate were recorded.We can draw some conclusions from the study:Firstly,there was significant improvement of liver function in the treatment group after 1 year lamivudine,compared with that in the control group (p<0.05). The level of alanine transaminase (ALT),aspartate aminotransferase (AST) and total bilirubin (TB) decreased significantly in the treatment group,but the albumin(ALB) and prothrombin time(PT) levels did not show any significant change. Secondly,the complication rate and morality rate decreased significantly in the treatment group after 1 year lamivudine,compared with that of control group. Thirdly,as the CPT score is closely related with prognosis,the score of treatment group is 3 cores lower than that of control group.The standard to suspend lamivudine treatment for HBV-related decompensated liver cirrhosis is different from that for CHB. Patients may have to continue the therapy for a long time even life-long. After the emergence of YMDD mutants in the course of therapy,lamivudine is still effective after YMDD mutations,but this conclusion needs to be confirmed by more data.Our study shows that lamivudine is highly effective in HBV-related decompensated liver cirrhosis. We can draw preliminary conclusion about when to suspend lamivudine therapy and how to treat the patients after emergence of YMDD mutations. But further study including a much larger number of patients are needed to confirm our conclusions.