目的 探究熊去氧胆酸联合阿德福韦酯和替比夫定治疗失代偿期乙型肝炎肝硬化的临床疗效。方法 选择2012年5月-2014年5月西安市第八医院收治的失代偿期乙型肝炎肝硬化患者128例作为研究对象，随机分为对照组和治疗组，每组各64例。对照组口服阿德福韦酯片，10 mg/次，1次/d；同时口服替比夫定片，600 mg/次，1次/d。治疗组在对照组基础上口服牛磺熊去氧胆酸胶囊，10 mg/kg，3次/d。两组患者均治疗50周。观察两组的临床疗效，比较两组抗病毒疗效、肝功能指标和Child-Pugh评分。结果 治疗后，对照组和治疗组的总有效率分别为84.3%、85.9%，两组比较差异无统计学意义；但是两组显著改善率分别为54.7%、68.7%，有效率分别为29.7%、17.2%，两组比较差异有统计学意义（P<0.05）。治疗后，两组脱氧核糖核酸（HBV-DNA）转阴率、乙型肝炎e抗原（HBeAg）血清学转换率、丙氨酸转氨酶（ALT）复常率及病毒学突破率比较差异均无统计学意义。治疗后，两组白蛋白（ALB）和凝血酶原活动度（PTA）均显著升高，而血清总胆红素（TBIL）和ALT均显著下降，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组这些观察指标的改善程度明显优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组Child-Pugh评分均明显降低，同组治疗前后差异有统计学意义（P<0.05）；治疗30周、40周和50周后，治疗组Child-Pugh评分降低幅度比对照组同期更大，两组比较差异具有统计学意义（P<0.05）。结论 熊去氧胆酸联合阿德福韦酯和替比夫定治疗失代偿期乙型肝炎肝硬化具有较好的临床疗效，能改善患者肝功能，降低Child-Pugh评分，具有一定的临床推广应用价值。

Objective To investigate the effect of ursodeoxycholic acid combined with adefovir dipivoxil and telbivudine in treatment of hepatitis B decompensated cirrhosis. Methods Patients (128 cases) with hepatitis B decompensated cirrhosis in the Eighth Hospital of Xi'an from May 2012 to May 2015 were randomly divided into control and treatment groups, and each group had 64 cases. Patients in the control group were po administered with Adefovir Dipivoxil Tablets, 10 mg/time, once daily. And patients in the control group were also po administered with Telbivudine Tablets, 600 mg/time, once daily. Patients in the treatment group were po administered with Tauroursodeoxycholic Acid Capsules on the basis of the control group, 10 mg/kg, three times daily. Patients in two groups were treated for 50 weeks. After treatment, the efficacies were evaluated, and antiviral effect, liver function indexes, and Child-Pugh scores in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 84.3%, and 85.9%, and there was no differences between two groups. The significant improvement rate in the control and treatment groups were 54.7% and 68.7%, respectively, and the efficacies in the control and treatment groups were 29.7% and 17.2%, respectively, and there was difference between two groups (P<0.05). After treatment, HBV-DNA negative conversion rate, HBeAg serological conversion rate, ALT recovery rate, and virological breakthrough rate in two groups had no difference. After treatment, ALB and PTA in two groups were significantly increased, but TBIL and ALT in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the Child-Pugh scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment for 30, 40, and 50 weeks, the Child-Pugh scores in the treatment group were lower than those at the same period in the control group, with significant difference between two groups (P<0.05). Conclusion Ursodeoxycholic acid combined with adefovir dipivoxil and telbivudine has clinical curative effect in treatment of hepatitis B decompensated cirrhosis, and can improve liver function, induce Child-Pugh scores, which has a certain clinical application value.