Objective To investigate the clinical effect of entecavir(ETV) combined with adefovir dipivoxil (ADV) in the treatment of adefovir-resistant hepatitis B cirrhosis.Methods 125 cases of liver cirrhosis with adefovir-resistantce were selected,they were divided into two groups.The treatment group included 67 cases who received the combined therapy with ETV and ADV.The control group included 58 cases who were treated with ETV.The ALT negative rate,HBV-DNA negative rate,HBeAg conversion rate,liver function Child-pugh score conversion rates were compared between the two groups within 12,24,48 weeks.Results After treatment for 12,24,48 weeks,in the treatment group,the ALT negative rates were 65.5％,81.0％,96.6％,respectively,the HBV-DNA negative rates were 62.0％,69.0％,77.6％,respectively,the HBeAg conversion rates were 0.0％,0.0％,17.2％,respectively.The ALT negative rate and HBV-DNA negative rate of the treatment group were higher than those in the control group within 12 and 24 weeks,the differences were statistically significant(ALT negative rate after 12 and 24 weeks,x2 =14.64,8.23;HBV-DNA negative rate after 12 and 24 weeks,x2 =4.57,14.24).The HBeAg conversion rate had no statistically significant difference between the two groups at any time.After treatment for 48 weeks,the Child-pugh score of the treatment group was (6.05 ± 2.11)points,which was significantly lower than (7.67 ± 1.12)points of the control group (t =1.89,P ＜ 0.05).The incidence rate of adverse reactions between the two groups had no statistically significant difference (P ＞ 0.05).Conclusion Entecavir combined with adefovir dipivoxil in the treatment of patients with hepatitis B cirrhosis has good effect on the ALT negative rate,HBV-DNA negative rate.It is worthy of clinical application.

Objective:To investigate the efficacy of Dahuang Zhechong pill combined with tenofovir disoproxil fumarate in treating liver fibrosis of chronic hepatitis B and its effect of intestinal flora.Methods:One hundred and twenty chronic hepatitis B cases with liver fibrosis treating in Rugao Hospital Affiliated to Nantong University from March 2018 to November 2019 were randomly divided into the control group and the observation group with 60 cases in each group according to the random number table. The control group was orally given with tenofovir disoproxil fumarate (1 tablet/time and quaque die).The observation group was treated with Dahuang Zhechong pill(3 g/time and bis in die) at basis of control group. The course was for 48 weeks for two groups. Liver function, liver fibrosis, hepatitis B virus e antigen(HBeAg) negative conversion rate, hepatitis b virus (HBV)-DNA negative conversion rate, the efficacy and intestinal flora changes were compared between the two groups before and after treatment. The adverse reactions were recorded in two groups.Results:After treatment, the levels of aspartic transaminase(AST), alanine aminotransferase (ALT), gamma-glutamyltransferase(GGT), total bilirubin (TBIL) in observation group were lower than those in control group [(41.62 ± 5.93) U/L vs. (50.41 ± 7.12) U/L, (41.99 ± 5.76) U/L vs. (52.17 ± 7.09) U/L, (34.46 ± 5.31) U/L vs. (49.41 ± 6.23) U/L, (20.35 ± 3.04) μmol/L vs. (25.60 ± 3.95) μmol/L], and the differences were statistically significant ( P<0.05). After treatment, the levels of hyaluronic acid (HA), procollagen Ⅲ (PCⅢ), type Ⅳ collagen (Ⅳ-C), Laminin(LN) in observation group were lower than those in control group [(167.45 ± 18.75) μg/L vs. (209.44 ± 22.96) μg/L, (103.44 ± 12.75) μg/L vs. (140.08 ± 16.33) μg/L, (81.41 ± 10.06) μg/L vs. (126.36 ± 14.94) μg/L, (108.41 ± 12.72) μg/L vs. (169.41 ± 19.22) μg/L], and the differences were statistically significant ( P<0.05). The total effective rate in the observation group was higher than that in the control group [91.67%(55/60) vs. 76.27%(45/59)], and the difference was statistically significant ( P<0.05). The negative conversion ratio of HBeAg, HBV-DNA in the observation group were higher than those in the control group [28.33%(17/60) vs. 11.86%(7/59), 83.33%(50/60) vs. 66.10%(39/59)], and the differences were statistically significant ( P<0.05). Compared with the control group, the levels of bifidobacteria and lactobacillus in the observation group were higher and the levels of escherichia coli and enterococcus in observation group were lower, and the improvement of intestinal flora in the observation group were better than those in the control group ( P<0.01). Conclusions:Dahuang Zhechong pill combined with tenofovir disoproxil fumarate in treating liver fibrosis of chronic hepatitis B can improve the liver function and liver fibrosis, and can improve the serological conversion rate of HBeAg, inhibit HBV DNA replication, increase the therapeutic effect, and is safety. The effect of Dahuang Zhechong pill on intestinal flora may be related to the curative effect.