目的 对比分析阿德福韦酯和拉米夫定初始联合与优化治疗失代偿期乙型肝炎肝硬化的临床疗效。方法 选择2010年10月~2013年10月在延安大学附属医院进行诊治的失代偿期乙型肝炎肝硬化患者300例，随机分为联合组和优化组，两组均连续治疗1年。联合组采用阿德福韦酯和拉米夫定初始联合治疗，优化组先给予拉米夫定治疗6个月，对患者的血清HBV DNA水平进行检测，如果HBV DNA水平大于1×10³拷贝/mL，加用阿德福韦酯，继续治疗6个月。观察和比较两组的HBV DNA复常率、丙氨酸氨基转移酶（ALT）复常率、HBe Ag转阴率，ALT、总胆汁酸（TBIL）、白蛋白水平和腹水消退情况。结果 联合组的HBV DNA复常率、ALT复常率和HBe Ag转阴率均明显高于优化组（P<0.05）；两组治疗后的ALT、TBIL、白蛋白好转情况和腹水消退情况均明显优于治疗前（P<0.05），联合组的改善情况明显优于优化组（P<0.05）；两组治疗前后的肌酸激酶水平和肾功能均无明显差异。结论 阿德福韦酯和拉米夫定初始联合治疗失代偿期乙型肝炎肝硬化的临床疗效优于优化治疗。

Objective To analyze the curative effect of primary combination and optimized therapy of lamivudine and adefovir dipivoxil for patients with hepatitis B virus-related decompensated cirrhosis. Methods Totally 300 cases of patients with hepatitis B virus-related decompensated cirrhosis who were treated in Yan'an University Affiliated Hospital from September 2010 to September 2013 were selected and divided into combination group and optimization group randomly. The combination group were given lamivudine combined with adefovir dipivoxil, and the optimized group were given lamivudine treatment for 6 months, then the serum HBV DNA levels were tested, if HBV DNA levels>1×10³ copies/mL, plus adefovir dipivoxil. HBV DNA rate, cereal third transaminase rate, HBeAg overcast rate, cereal third transaminase, total bile acid, albumin levels, and ascites subsided were observed and compared. Results After treatment, recovery rate of HBV DNA, ALT and HBe Ag negative rate of combination group was significantly higher than that of optimal group (P<0.05). After treatment, the improvement of TBIL, ALT, and albumin and the situation of Ascites regression were significantly better than those before treatment (P<0.05), the improvement of the combination group was significantly better than that of the optimization group (P<0.05). The creatine kinase level and renal function before and after treatment had no obvious difference between two groups. Conclusion The combination therapy of lamivudine and adefovir dipivoxil for patients with hepatitis B virus-related decompensated cirrhosis has better curative effect than the optimized therapy.