博路定治疗肝硬化临床与病理随访林国贤黄庆华林玉英吴智宏何雄志叶向阳邱荣仙【摘要】目的观察恩替卡韦（博路定）治疗肝硬化患者IIBVDNA.HBcAg及肝脏病理学变化。方法门诊及住院的HBVDNA阳性肝硬化患者94例，其中失代偿22例，经肝穿活检病理确诊46例。给予博路定0.5mg.qd1,肝功异常者同时予以保肝降酶治疗，治疗时间24W以上。观察患者HBVDNA.HBeAg及肝肌病理学变化。结果94例患者中HBeAg阳性37例,阴性57例;治疗时间（24〜144）W,中位69WoHBeAg阳性者在24W、48W、96W及144W,IIBVDNA检测不到率分别为86.5%、86・2%.90.0%和83.3%；HBeAg阴转率分别为40.5%、5&6%.80.0%和50.0%,HBeAg血清转换率分别为10.8%、37.9%、40.0%和50.0%。HBeAg阴性者，HBVDNA检测不到率分别为87.7%、89.5%、100%和100%。22例患者治疗48W后行二次肝穿活检，1例治疗96W第三次肝穿活检。肝穿病理显示，22例患者肝组织炎症活动度、纤维化程度均有不同程度好转，16例（72.7%）患者假小叶消失,6例（27.3%）仍可见到假小叶，但数量明显减少。二例男性失代偿肝硬化患者，治疗24W后发现肝癌，继续应用博路定，其中一例102W病故。结论博路定对肝硬化具有良好的抗病毒疗效，经过长期治疗，患者病毒学、血清学及病理学均有明显改善；部分肝硕化患者的病理可以逆转，假小叶消失；但个别患者仍会进展为肝细胞癌。ClinicalandPathologicalFollow-upofTreatingLiverCirrhosiswithBaracludeLINGuo-xian,HUANGQing-hua,LINYu-ying,WUZhi-hong,HEXiong-zhi,YEXiang-yang,QIURun-xian.DepartmentofInfectiousDiseases,affiliatedHospitalofPutianColloge(teachingHospitalofFujianMedicalUniversty),Putian/Fujian,China,351100Correspondingauthor:LINGuo-xian,Email:lingx609@tom.com—作者单位：351100福建莆田,莆田学院附属医院感染性疾病科第一-作者：林国贤，男，48岁，主任医师，副教授，主要从事传染病的临床诊疗工作。Email:lingx609@tom.comObjectiveToobserveHBVDNA,HBeAgandliverpathologicalchangesforcirrhosis【关键词】慢性乙型肝炎；肝硬化；恩替卡韦；肝脏病理学patientstreatedwithentecavir(baraclude).Methods94casesofpositiveHBVDNAcirrhosisfrombothoutpatientandinpatient,ofwhom22casessufferedfromdecompensation,and46caseswerediagnosedpathologicallythroughliverpuncturebiopsy,weregivenbaraclude(0.5mg.qd),andthosewithabnormalliverfunctionweregivenliver-protectingandenzymes-decreasingtreatmentatthesametime;thetimeoftherapywasmorethan24W.HBVDNA,HBeAgandliverpathologicalchangesofthepatientswereobserved.ResultsAmongthe94cases,37casesshowedpositiveHBeAg,57caseswithnegativeHBerAg；thetimeoftherapywasbetween24Wto144W,andthemeso-positionwas69W,andthatforpositiveHBeAgwas24W,48W,96Wand144W;thefailuredetectionratesforHBVDNAwere86.5%,86.2%,90.0%and83.3%respectively;thenegativeconversionratesofHBeAgwere40.5%,58.6%,80.0%and50.0%respectively;theHBeAgseroconversionrateswere10.8%,37.9%,40.0%and50.0%respectively;thefailuredetectionratesofHBVDNAfornegativeHBeAgwere87.7%,89.5%,100%and100%respectively.22casesweregiventhesecondliverpuncturebiopsy48Wlater,1casewasgiventhethirdliverpuncturebiopsy96Wlate匚Thepathologyshowedthat22casesimprovedclearlyinthegradeofinflammatoryactivityandthestageoffibrosisoflivertissue,andthepseudolobulein16cases(72.7%)disappeared,6cases(27.3%)werestillwithpseudolobule,butthenumberswereobviouslydecreased.2malessufferingfromdecompensationcirrhosiswerefoundlivercancer24Wlaterandshouldbegivenbaracludecontinuously,oneofwhomdied102Wlate匚Conclusionsbaracludehasagoodantiviraleffectforcirrhosis,andthevirology,serologyandpathologyofthepatientswillimproveobviouslyafteralongtimetreatment；thepathologyforsomepatientscanreverseandthepseudolobulecandisappear;buthepatocellu...