目的 對比分析阿德福韋酯和拉米夫定初始聯(lián)合與優(yōu)化治療失代償期乙型肝炎肝硬化的臨床療效。方法 選擇2010年10月~2013年10月在延安大學(xué)附屬醫(yī)院進(jìn)行診治的失代償期乙型肝炎肝硬化患者300例，隨機(jī)分為聯(lián)合組和優(yōu)化組，兩組均連續(xù)治療1年。聯(lián)合組采用阿德福韋酯和拉米夫定初始聯(lián)合治療，優(yōu)化組先給予拉米夫定治療6個月，對患者的血清HBV DNA水平進(jìn)行檢測，如果HBV DNA水平大于1×10³拷貝/mL，加用阿德福韋酯，繼續(xù)治療6個月。觀察和比較兩組的HBV DNA復(fù)常率、丙氨酸氨基轉(zhuǎn)移酶（ALT）復(fù)常率、HBe Ag轉(zhuǎn)陰率，ALT、總膽汁酸（TBIL）、白蛋白水平和腹水消退情況。結(jié)果 聯(lián)合組的HBV DNA復(fù)常率、ALT復(fù)常率和HBe Ag轉(zhuǎn)陰率均明顯高于優(yōu)化組（P<0.05）；兩組治療后的ALT、TBIL、白蛋白好轉(zhuǎn)情況和腹水消退情況均明顯優(yōu)于治療前（P<0.05），聯(lián)合組的改善情況明顯優(yōu)于優(yōu)化組（P<0.05）；兩組治療前后的肌酸激酶水平和腎功能均無明顯差異。結(jié)論 阿德福韋酯和拉米夫定初始聯(lián)合治療失代償期乙型肝炎肝硬化的臨床療效優(yōu)于優(yōu)化治療。

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.