目的 探究熊去氧膽酸聯(lián)合阿德福韋酯和替比夫定治療失代償期乙型肝炎肝硬化的臨床療效。方法 選擇2012年5月-2014年5月西安市第八醫(yī)院收治的失代償期乙型肝炎肝硬化患者128例作為研究對象，隨機(jī)分為對照組和治療組，每組各64例。對照組口服阿德福韋酯片，10 mg/次，1次/d；同時(shí)口服替比夫定片，600 mg/次，1次/d。治療組在對照組基礎(chǔ)上口服?；切苋パ跄懰崮z囊，10 mg/kg，3次/d。兩組患者均治療50周。觀察兩組的臨床療效，比較兩組抗病毒療效、肝功能指標(biāo)和Child-Pugh評分。結(jié)果 治療后，對照組和治療組的總有效率分別為84.3%、85.9%，兩組比較差異無統(tǒng)計(jì)學(xué)意義；但是兩組顯著改善率分別為54.7%、68.7%，有效率分別為29.7%、17.2%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組脫氧核糖核酸（HBV-DNA）轉(zhuǎn)陰率、乙型肝炎e抗原（HBeAg）血清學(xué)轉(zhuǎn)換率、丙氨酸轉(zhuǎn)氨酶（ALT）復(fù)常率及病毒學(xué)突破率比較差異均無統(tǒng)計(jì)學(xué)意義。治療后，兩組白蛋白（ALB）和凝血酶原活動(dòng)度（PTA）均顯著升高，而血清總膽紅素（TBIL）和ALT均顯著下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)的改善程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組Child-Pugh評分均明顯降低，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療30周、40周和50周后，治療組Child-Pugh評分降低幅度比對照組同期更大，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 熊去氧膽酸聯(lián)合阿德福韋酯和替比夫定治療失代償期乙型肝炎肝硬化具有較好的臨床療效，能改善患者肝功能，降低Child-Pugh評分，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the effect of ursodeoxycholic acid combined with adefovir dipivoxil and telbivudine in treatment of hepatitis B decompensated cirrhosis. Methods Patients (128 cases) with hepatitis B decompensated cirrhosis in the Eighth Hospital of Xi'an from May 2012 to May 2015 were randomly divided into control and treatment groups, and each group had 64 cases. Patients in the control group were po administered with Adefovir Dipivoxil Tablets, 10 mg/time, once daily. And patients in the control group were also po administered with Telbivudine Tablets, 600 mg/time, once daily. Patients in the treatment group were po administered with Tauroursodeoxycholic Acid Capsules on the basis of the control group, 10 mg/kg, three times daily. Patients in two groups were treated for 50 weeks. After treatment, the efficacies were evaluated, and antiviral effect, liver function indexes, and Child-Pugh scores in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 84.3%, and 85.9%, and there was no differences between two groups. The significant improvement rate in the control and treatment groups were 54.7% and 68.7%, respectively, and the efficacies in the control and treatment groups were 29.7% and 17.2%, respectively, and there was difference between two groups (P<0.05). After treatment, HBV-DNA negative conversion rate, HBeAg serological conversion rate, ALT recovery rate, and virological breakthrough rate in two groups had no difference. After treatment, ALB and PTA in two groups were significantly increased, but TBIL and ALT in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the Child-Pugh scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment for 30, 40, and 50 weeks, the Child-Pugh scores in the treatment group were lower than those at the same period in the control group, with significant difference between two groups (P<0.05). Conclusion Ursodeoxycholic acid combined with adefovir dipivoxil and telbivudine has clinical curative effect in treatment of hepatitis B decompensated cirrhosis, and can improve liver function, induce Child-Pugh scores, which has a certain clinical application value.