目的 研究拉米夫定聯(lián)合阿德福韋酯與聚乙二醇干擾素α-2a治療慢性乙型肝炎的療效觀察。方法 選取2012年5月—2014年5月西安市唐都醫(yī)院傳染科收治的慢性乙肝患者80例,隨機(jī)分為對(duì)照組和治療組,每組各40例。對(duì)照組患者在綜合治療的基礎(chǔ)上口服阿德福韋酯片,10 mg/次,1次/d,同時(shí),腹部皮下注射聚乙二醇干擾素α-2a注射液180 μg,1次/周。治療組患者在對(duì)照組基礎(chǔ)上口服拉米夫定片,0.1 g/次,1次/d。兩組均連續(xù)治療12周。觀察兩組的臨床療效,同時(shí)比較兩組治療前后總膽紅素、丙氨酸轉(zhuǎn)氨酶(ALT)、血清白蛋白、HBV-DNA的變化。記錄兩組HBV-DNA轉(zhuǎn)陰、HBeAg轉(zhuǎn)陰及ALT復(fù)常情況。應(yīng)用健康狀況調(diào)查問(wèn)卷(SF-36)對(duì)兩組患者的生活質(zhì)量進(jìn)行評(píng)定。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為70.0%、90.0%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療后,兩組總膽紅素、ALT、HBV-DNA均顯著降低,血清白蛋白均顯著升高,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療組患者的HBV-DNA轉(zhuǎn)陰率、HBeAg轉(zhuǎn)陰率及ALT復(fù)常率均顯著高于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療后,兩組患者的生理機(jī)能、生理職能、精神健康、情感職能評(píng)分及總分均顯著升高,社會(huì)功能、軀體疼痛、活力評(píng)分均顯著降低,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05);且治療組這些項(xiàng)目評(píng)分的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。結(jié)論 拉米夫定聯(lián)合阿德福韋酯和聚乙二醇干擾素α-2a治療慢性乙型肝炎的臨床效果顯著,能夠有效改善患者的肝功能和生活質(zhì)量,且不會(huì)增加患者的不良反應(yīng),具有一定的臨床推廣應(yīng)用價(jià)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.