A Clinical Study Of Lamivudine And Adefovir Dipivoxil In The Treatment Of Decompensated Cirrhosis Resulting From Chronic Hepatitis B

Objective:To evaluate and compare the clinical efficacy and safety of lamivudine(LAM) and adefovir dipivoxil(ADV) in the treatment of decompensated cirrhosis resulting from hepatitis B,and to discuss the remedy strategy for the resistance.Methods:The retrospective study data were collected from consecutive patient's files. All patients were hepatitis B relative decompensated cirrhosis, LAM group,patients treated with 100mg of lamivudine daily,and ADV group, patients treated with 10mg of adefovir dipivoxil daily,and no antiviral treatment group. To sort and analyse the following variables:age, sex,liver biochemistry,prothrombintime,HBVDNAlevel,HBeAg/HBeAb,Child-Pugh,abdominal ultrasound,changes of the clinical symptoms and signs,adverse drug reactions and so on.Result:Statistical analysis the above data at the months 6,12,18 and 24 respectively. With the extension of treatment, the clinical symptoms and signs of LAM and ADV groups were improved obviously. A significant improvement was observed in ALT, ALB, TBIL,PT and Child-Pugh of LAM and ADV groups compared to baseline and no-antiviral group(P<0.05),but there was no significant difference between LAM and ADV groups.The serum HBV-DNA normalization rate and HBeAg normalization rate were superior to no-antiviral group,but there was no significant difference between LAM and ADV groups.The rate of virologic breakthrough in the LAM group were 15.4% and 25.0%,which were detected within12 months and 24 months respectively; the counterpart to ADV group were 2.4% and 6.9%,which have statistically significant between two groups.For these patients had virologic breakthrough can obtain good effect with combination lamivudine and adefovir dipivoxil for treatment.No patient in the LAM and ADV groups developed obvious adverse reactions throughout the course of treatment.There was no significant difference in side effects in both groups.Conclusions:Lamivudine and Adefovir dipivoxil have better efficacy and security in the antiviral treatment of decompensated cirrhosis resulting from hepatitis B,but the ratio of virus-resistant mutation was lower in adefovir dipivoxil group.Combination therapy(LAM and ADV) was effective for LAM-resistant or ADV-resistant.