抗病毒治疗对失代偿期乙肝肝硬化患者预后的影响  

Effect of antiviral therapy on prognosis of patients with decompensated cirrhosis

作　　者：黄玉波[1] 乔雍[1] 常路丝[1] 郝小花[1] 肖凡[1] 魏红莲[2] 张仁雯[3] 成军[1] 魏红山[1] 

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]首都医科大学附属北京同仁医院 [3]北京大学医学部研究生院

出　　处：《胃肠病学和肝病学杂志》2011年第4期331-334,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金资助(No.30671875;No.30872243)

摘　　要：目的观察抗病毒治疗对失代偿肝硬化患者生存时间及肝癌发生的影响。方法回顾性分析1998年1月~2009年12月,于北京地坛医院住院至少3次或3次以上的HBV感染相关的失代偿肝硬化患者,抗病毒治疗对其预后的影响。所有分析对象是在最后1次住院期间死亡的患者。其中男168例,女69例。237例患者中70例患者接受了连续6个月以上的抗病毒治疗。耐药检测采用PCR法扩增病毒聚合酶相应的基因片段,并进行测序分析。结果接受核苷类似物抗病毒治疗的70例患者生存时间（34.44±28.39）个月,显著长于未接受治疗的患者（27.12±24.29）个月。167例未接受抗病毒治疗的失代偿肝硬化患者中,最终60例死亡前被确诊为肝癌,发生率为35.93%（60/167）;而接受抗病毒治疗的70例患者中,20例死亡前被确诊为肝癌,肝癌发生率为28.57%（20/70）。两组比较无显著性差异（P=0.37）。治疗期间6例患者出现耐药,但未出现病情加重。结论核苷类似物对HBV感染失代偿肝硬化患者的治疗有助于延长患者的生存期,但不能降低肝癌的发生。Objective To observe the effect of antiviral therapy on the survival time of patients with decompensated liver cirrhosis and occurrence of hepatocellular carcinoma（HCC）.Methods All of the subjects（237 cases） were diagnosed as patients with decompensated cirrhosis from January 1998 to December 2009,received treatment at Beijing Ditan Hospital at least 3 times or more.All of the subjects died during his/her last hospitalization.Subjects included 168 males and 69 females.29.54%（70/237） patients received at least 6 months anti-viral therapy.Drug resistance was determined by PCR amplification and sequencing method.Results The survival time of patients receiving antiviral therapy（34.44±28.39 months） was significantly longer than that of untreated patients（27.12±24.29 months）.All of 167 patients without receiving antiviral therapy,35.93%（60/167） patients were diagnosed as liver cancer before death;28.57%（20/70） patients receiving antiviral treatment were diagnosed as liver cancer before death.There was no statistically significant difference of incidence rate of liver cancer between two groups（P=0.37）.There were 6 patients developing drug-resistance,but no disease aggravation was observed.Conclusion Antiviral therapy may help to prolong survival time of patients with decompensated cirrhosis,but can not reduce the incidence of liver cancer.

关 键 词：慢性乙型肝炎 肝硬化 失代偿期 核苷类似物 

分 类 号：R575.2[医药卫生—消化系统]