Abstract: Objective To assess the efficacy and safety of telbivudine therapy on HBV DNA positive decompensated hepatitis B cirrhosis patients.Methods A total of 55 patients with decompensated hepatitis B cirrhosis were randomly divided into 2 groups.Treatment group of 28 cases:liver protection treatment plus telbivudine 600 mg/d orally and control group of 27 cases:conventional Liver protection treatment.Both the patient and the control groups were followed for 104 weeks.Clinical, biochemical, virological indexes Child-Pugh score and mortality were compared before and after treatment.Results After 104 weeks of treatment, the rate of symptomic and liver function remission were 71.4% (20/28) and 48.1% (13/27) (P <0.05) in the treatment and control groups respectively.The HBV DNA levels in the treatment group were significantly decreased.The negative rate of HBV DNA (< 500 copies/ml) at 4, 12, 26, 52 and 104 weeks were 46.4% (13/28) , 64.3% (18/28) , 71.4% (20/28) , 75.0% (21/28) and 75.0% (21/28) , respectively in the treatment groups.However, there was no significant difference between the treatment and the control group.Treatment group Child Pugh score decreased from (10.5 ± 0.7) to (5.9 ± 0.5) ;and in the control group Child-Pugh score decreased from (10.4 ±0.8) to (8.7 ±0.4) .There was a significant difference between the two groups (P <0.05) .The mortality rate after 104-week of treatment were 17.9% (5 /28) and 37.0% (10 /27) in the treatment and control group respectively (P < 0.01) .Conclusion Telbivudine could significantly inhibit viral replication, improve liver function, slow disease progression, improve survival, and good security in decompensated hepatitis B cirrhosis patients with viral replication.