关键词: 乙型肝炎, 肝硬化, 替诺福韦酯, 拉米夫定, 阿德福韦酯, 抗病毒药, 治疗结果

Abstract: Background　Antiviral treatment is an important means of treating HBV-related liver cirrhosis.Classical antiviral drugs are prone to drug resistance.Tenofovir is a new antiviral drug that can be used to save HBV-related decompensated liver cirrhosis patients experiencing antiviral treatment failure.Objective　To evaluate the clinical efficacy of tenofovir on HBV-related decompensated liver cirrhosis patients experiencing treatment failure with lamivudine alone or combined with lamivudine and adefovir dipivoxil.Methods　37 decompensated HBV-related decompensated liver cirrhosis patients who experienced treatment failure with lamivudine alone or combined with lamivudine and adefovir dipivoxil were selected from No.965 Hospital of PLA Joint Logistic Support Force from December 2014 to October 2017.The treatment regimen was changed to a 48-week course of oral administration of adefovir dipivoxil（300 mg，once daily）.And they were treated with oral TDF（300 mg/times/day） for 48 weeks.The level of HBV-DNA，HBV-DNA negative conversion rate，HBeAg negative conversion rate，liver functions，FibroScan values and incidence of complications were compared before and after the treatment.Results　The levels of HBV-DNA，ALT，total bilirubin（TBiL） and FibroScan values were lower，and levels of albumin（ALB），cholinesterase（CHE） and prothrombin activity（PTA） after 24-week and 48-week treatments were higher than those before the treatment（P<0.05）.And 48-week treatment further decreased HBV-DNA and FibroScan values，and increased ALB and CHE in comparison with 24-week treatment（P<0.05）.The negative conversion rates of HBV-DNA and HBeAg were 34.3%（12/35） and 11.4%（4/35），respectively after 24-week treatment，and were 60.0%（21/35） and 22.9%（8/35），respectively after 48-week treatment.Compared to baseline status，the incidence of peritoneal effusion and spontaneous peritonitis after 24-week treatment was lower（P<0.01），and further decreased after 48-week treatment（P<0.01）.There was no significant difference in the incidence of digestive tract hemorrhage，hepatic encephalopathy and hepatorenal syndrome before and after the treatment（P>0.05）.During the treatment, 1 case died of digestive tract hemorrhage, 1 case died of primary liver cancer.Conclusion　Tenofovir dipivoxil could continuously inhibit the replication of HBV，increase the negative conversion rate of HBV-DNA，improve liver function effectively，and lower the degree of hepatic fibrosis and incidence of complications.It may be an ideal alternative medicine for HBV-related decompensated liver cirrhosis patients experiencing antiviral treatment failure with lamivudine.

Key words: Hepatitis B, Liver cirrhosis, Tenofovir, Lamivudine, Adefovir, Antiviral agents, Treatment outcome