核苷（酸）类似物对失代偿性乙型肝炎肝硬化长期预后的影响  

Long-term prognosis of patients with HBV-related decompensated cirrhosis treated by nucleos （t）ide analogues

作　　者：谢仕斌[1] 曾丽娇[1] 张英[1] 朱建芸[1] 马超[1] 高志良[1] 

机构地区：[1]中山大学附属第三医院感染病科,广州510630

出　　处：《中华临床感染病杂志》2009年第4期201-204,共4页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的评价核苷（酸）类似物对失代偿性乙型肝炎肝硬化患者长期预后的影响。方法选取53例失代偿性乙型肝炎肝硬化患者，在常规护肝、对症治疗的同时，每天口服拉米夫定（100mg/d）、阿德福韦酯（10mg／d）或恩替卡韦（0．5mg／d）。另选取同时期仅行常规护肝、对症治疗的41例失代偿性乙型肝炎肝硬化患者为对照组。发生肝癌、肝移植、死亡或拒绝继续治疗者停止随访。随访结束时分析比较2组治疗前后血清肝功能指标和Child—Push分级的变化及临床结局。结果治疗组ALT、AST、球蛋白（Glb）和TBil均较治疗前下降，Alb及胆碱酯酶（CHE）较治疗前升高，43例（81．1％）患者的Child-Pugh分级下降。对照组治疗前后ALT、AST、Glb和TBil变化差异无统计学意义，但CHE较治疗前明显降低，差异有统计学意义（t=5．225，P〈0．01）。2组Child-Pugh分级变化差异有统计学意义（x^2=52.16，P〈0．01），治疗组明显好于对照组。治疗组与对照组发生肝癌比例分别为0．0％和19．5％，差异有统计学意义（x^2=23．07，P〈0．01），但在病死率及需要接受肝移植的比例方面2组的差异不明显。结论核苷（酸）类似物长期治疗失代偿性乙型肝炎肝硬化可以改善患者肝功能状况，改善患者的预后，并有可能降低肝癌的发生机会。Objective To evaluate the long-term prognosis of patients with HBV-related decompensated cirrhosis after treatment with nucieos （t） ide analogues. Methods Totally 94 patients with HBV-related decompensated cirrhosis were enrolled, 53 in nueleos（t）ide group, 41 in control group, and both received routine treatments. Patients in nucleos （t）ide analogue group also received lamivudine （100 mg/d） , or adefovir （10 mg/d） , or entecavir （0.5 mg/d）. The follow-up was terminated for those who developed hepatocellular carcinoma, received liver transplantation, died or refused the treatment. Serum biochemical markers, Child-Pugh grades and clinical outcomes were compared between two groups at the end of following up. Results After nucleos （t） ide analogues therapy, ALT, AST, globulin （ Glb）, and TBil decreased, while Alb and cholinesterase （ CHE ） increased in the nueleos （ t ） ide group, and Child-Pugh scores decreased in 43 （81.1%） patients. While in the control group, ALT, AST, Glb and TBil did not show significant changes, but the CHE was significantly lower than before （t = 5. 225,P 〈 0. 01 ）. More patients in nueleos （t）ide group showed improvements in Child-Pugh grades, and there was significant difference between the two groups （X^2 = 52.16, P 〈 0.01 ）. The incidence of HCC is lower in nucleos （t） ide group （0%） than that in the control group （19.5%） （X^2 = 23.07, P 〈 0.01 ）. The incidence of death and liver transplantation between two groups did not show significant difference. Conclusions Nucleos （t） ide analogues therapy can significantly improve biochemical status of liver functions in patients with HBV- related decompensated cirrhosis. The incidence of hepatocellular carcinoma may decline and the long-term prognosis can be improved.

关 键 词：肝炎病毒 乙型 失代偿性肝硬化 核苷(酸)类似物 预后 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]