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

摘要： 背景　抗病毒治疗是治疗乙型肝炎后肝硬化的重要手段，经典抗病毒药物治疗乙型肝炎后肝硬化患者易产生耐药性，替诺福韦酯是一种新的抗病毒药物，可用于挽救治疗临床抗病毒治疗失败的失代偿期乙型肝炎后肝硬化患者。目的　探讨替诺福韦酯挽救拉米夫定单独或联合阿德福韦酯治疗失败的失代偿期乙型肝炎后肝硬化患者的临床疗效。方法　选取2014年12月—2017年10月在中国人民解放军联勤保障部队第965医院就诊的失代偿期乙型肝炎后肝硬化患者37例，改为口服替诺福韦酯300 mg/次，1次/d，持续观察48周。比较治疗前、后患者乙型肝炎病毒（HBV）-DNA水平、HBV-DNA阴转率、乙型肝炎e抗原（HBeAg）阴转率、肝功能、FibroScan弹力值和并发症发生率。结果　治疗24、48周HBV-DNA、丙氨酸氨基转移酶（ALT）、总胆红素（TBiL）水平、FibroScan弹力值低于治疗前，清蛋白（ALB）、胆碱酯酶（CHE）、凝血酶原活动度（PTA）水平高于治疗前（P<0.05）；治疗48周HBV-DNA水平、FibroScan弹力值低于治疗24周，ALB、CHE水平高于治疗24周（P<0.05）。治疗24周HBV-DNA阴转率为34.3%（12/35），HBeAg阴转率为11.4%（4/35）；治疗48周HBV-DNA阴转率为60.0%（21/35），HBeAg阴转率为22.9%（8/35）。治疗24周患者腹腔积液、自发性腹膜炎发生率低于治疗前（P<0.01），且治疗48周患者腹腔积液、自发性腹膜炎发生率低于治疗24周（P<0.01）；治疗前后消化道出血、肝性脑病和肝肾综合征发生率比较，差异均无统计学意义（P>0.05）。治疗期间1例死于消化道出血，1例死于原发性肝癌。结论　替诺福韦酯可以持续抑制拉米夫定单独或联合阿德福韦酯治疗失败的失代偿期乙型肝炎后肝硬化患者体内HBV的复制，HBV-DNA阴转率高，同时有效改善肝功能，降低肝纤维化程度，减少并发症的发生，是理想的拉米夫定抗病毒治疗失败患者的替代药物。

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