拉米夫定对乙型肝炎相关失代偿肝病患者预后的影响  

The effect of lamivudine treatment on the prognosis of patients with hepatitis B related decompensative liver diseases

作　　者：杨方[1] 吴云海[1] 刘丹阳[1] 李维利[1] 魏倪 

机构地区：[1]沈阳市传染病院肝硬化病房,110006

出　　处：《中华传染病杂志》2008年第1期46-49,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨长期拉米夫定治疗对伴有HBV复制的失代偿肝病患者预后的影响。方法采取随机、对照队列研究方法，将168例患者分为应用拉米夫定的试验组及未用拉米夫定的对照组，直至患者发生终点事件或研究结束（研究截止日为2006年6月30日），准确记录生存叫间。终点事件定义为肝病相关死亡或确诊为肝细胞癌（HCC）。采用Kaplan—Meier检验进行生存分析，并计算生存率，对可能影响预后的因素引入Cox比例风险模型，作多因素回归分析。结果至研究结束，对照组中位生存时间为635d，2年生存率为41．4％。实验组患者因其至研究结束时生存率超过50．0％，故无法估计中位生存时间，2年生存率为84．6％（Log—rank检验：Χ^2=29．377，P=0．000）。将17个经单因素分析对预后有影响的变量引入Cox模型，在α=0．05水平上，抗病毒治疗是影响预后的独立保护性因素（β=-1．180，RR=0．307，P=0．000）。结论长期拉米夫定治疗能延长乙型肝炎相关失代偿肝病患者的存活时间及发展为HCC的时间，在一定程度上改善预后。Objective To explore the effect of long-term lamivudine treatment on the prognosis of patients with decompensative liver diseases with hepatitis B virus（HBV） replication. Methods A prospective cohort study was performed in 168 patients who were divided into lamivudine treated group and control group randomly. They were followed up until the presence of clinical endpoint or the end of study and survival time was recorded precisely. Clinical endpoints were defined as death due to liver diseases or the presence of hepatocellular carcinoma（HCC）. Kaplan-Meier survival analysis was used for analysis of survival time and survival rate. Cox regression analysis was used to predict possible factors affecting the disease prognosis. Results By the end of study, median survival time of control group was 635 days. The median survival time was failed to be estimated in lamivudine treated group since its survival rate was more than 50%. Two-year survival rate was 41.4G and 84.6G in control and lamivudine group, respectively（Log-rank test Χ^2 = 29. 377, P = 0. 000）. Cox regression analysis showed anti-virus therapy was an independent protective factor affecting the disease prognosis （β= -1. 180, RR = 0. 307, P = 0. 000）. Conclusions Long-term lamivudine treatment might prolong the survival time and the time of developing to HCC in patients with hepatitis B related decompensative liver diseases. It may have a protective effect on the disease prognosis.

关 键 词：肝炎 乙型 预后 随机对照试验 拉米夫定 

分 类 号：R512.62[医药卫生—内科学] R575[医药卫生—临床医学]