目的 研究拉米夫定联合阿德福韦酯与聚乙二醇干扰素α-2a治疗慢性乙型肝炎的疗效观察。方法 选取2012年5月—2014年5月西安市唐都医院传染科收治的慢性乙肝患者80例,随机分为对照组和治疗组,每组各40例。对照组患者在综合治疗的基础上口服阿德福韦酯片,10 mg/次,1次/d,同时,腹部皮下注射聚乙二醇干扰素α-2a注射液180 μg,1次/周。治疗组患者在对照组基础上口服拉米夫定片,0.1 g/次,1次/d。两组均连续治疗12周。观察两组的临床疗效,同时比较两组治疗前后总胆红素、丙氨酸转氨酶(ALT)、血清白蛋白、HBV-DNA的变化。记录两组HBV-DNA转阴、HBeAg转阴及ALT复常情况。应用健康状况调查问卷(SF-36)对两组患者的生活质量进行评定。结果 治疗后,对照组和治疗组的总有效率分别为70.0%、90.0%,两组比较差异有统计学意义(P< 0.05)。治疗后,两组总胆红素、ALT、HBV-DNA均显著降低,血清白蛋白均显著升高,同组治疗前后差异具有统计学意义(P< 0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P< 0.05)。治疗组患者的HBV-DNA转阴率、HBeAg转阴率及ALT复常率均显著高于对照组,两组比较差异具有统计学意义(P< 0.05)。治疗后,两组患者的生理机能、生理职能、精神健康、情感职能评分及总分均显著升高,社会功能、躯体疼痛、活力评分均显著降低,同组治疗前后差异具有统计学意义(P< 0.05);且治疗组这些项目评分的改善程度优于对照组,两组比较差异具有统计学意义(P< 0.05)。结论 拉米夫定联合阿德福韦酯和聚乙二醇干扰素α-2a治疗慢性乙型肝炎的临床效果显著,能够有效改善患者的肝功能和生活质量,且不会增加患者的不良反应,具有一定的临床推广应用价值。

Objective To study the clinical effect of lamivudine combined with adefovir dipivoxil and peginterferon α-2a in treatment of chronic Hepatitis B. Methods Patients (80 cases) with chronic Hepatitis B in Department of Infection of Xi'an Tangdu Hospital from May 2012 to May 2014 were randomly divided into control and treatment groups, and each group had 40 cases. The patients in the control group were po administered with Adefovir Dipivoxil Tablets on the basis of comprehensive treatment, 10 mg/time, once daily, and they were sc administered with Peginterferon α-2a Solution for injection (180 μg), once daily. The patients in the treatment group were po administered with Lamivudine Tablets on the basis of the control group, 0.1 g/time, once daily. The patients in two groups were treated for 12 weeks. After treatment, the efficacy was evaluated, the changes of total bilirubin, alanine aminotransferase (ALT), serum albumin, and HBV-DNA were compared. The negative conversion ratios of HBV-DNA, HBeAg, and ALT in two groups were recorded. Health questionnaire (SF-36) was applied to assess the life quality. Results After the treatment, the efficacies in the control and treatment groups were 70.0% and 90.0%, respectively, and there was difference between two groups (P < 0.05). After treatment, total bilirubin, ALT, and HBV-DNA in two groups were significantly decreased, serum albumin was significantly increased, and the difference was statistically significant in the same group (P < 0.05). The improved degree of those observation indicators in the treatment group was better than that in the control group, with significant difference between two groups (P < 0.05). The negative conversion ratios of HBV-DNA, HBeAg, and ALT in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P < 0.05). The scores of physiological function, physical function, mental health, emotional function, and total score in the treatment group were significantly higher, and the scores of social function, body pain, and vitality scores were significantly lower, and the difference was statistically significant in the same group (P < 0.05). The improved degree of those observation indicators in the treatment group was better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Lamivudine combined with adefovir dipivoxil and peginterferon α-2a has remarkable clinical effect in treatment of chronic Hepatitis B, and can effectively improve liver function and life quality with less adverse reactions, which has a certain clinical application value.