抗病毒治疗对乙型肝炎病毒相关慢加急性肝衰竭患者预后的影响  

The influence and prognostic value of antiviral therapy on 90-day outcome of hepatitis B virus-related acute-on chronic liver failure patients

作　　者：汤伯宗[1] 潘奇[1] 陆云飞[1] 徐庆年[1] 杨宗国[1] 陈晓蓉[1] 

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《临床肝胆病杂志》2012年第10期748-751,共4页Journal of Clinical Hepatology

基　　金："十一五"国家科技重大专项(2008ZX10005-006)

摘　　要：目的探讨影响乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的因素及抗病毒治疗对HBV-ACLF患者90 d预后的影响。方法回顾性分析2009年1月-2011年6月在我院住院治疗的HBV-ACLF患者112例,根据入组时是否采用抗病毒治疗分为非抗病毒治疗组54例和抗病毒治疗组58例。非抗病毒治疗组采用内科综合治疗,抗病毒治疗组在内科综合治疗基础上加用抗病毒药物治疗,比较两组患者临床特征、存活率、抗病毒治疗短期疗效及分析影响预后的因素。结果治疗4周后,两组ALT均显著降低,胆碱酯酶(CHE)和HBV DNA转阴率提高(P<0.05);治疗8周后,抗病毒治疗组TBil和MELD评分明显低于非抗病毒治疗组,而凝血酶原活动度(PTA)水平明显高于非抗病毒治疗组(P<0.05)。治疗90 d,抗病毒治疗组累积存活率明显高于非抗病毒治疗组(P=0.025)。影响预后的独立危险因素为:HBeAg、肝性脑病、肝肾综合征、抗病毒治疗(P<0.05)。结论抗病毒治疗可提高HBV-ACLF患者的90 d存活率,是HBV-ACLF内科治疗的有效方法之一;HBeAg阴性、肝性脑病、肝肾综合征也可降低HBV-ACLF患者的90 d存活率。Objective To investigate the influence and prognostic value of antiviral therapy on the 90 - day outcome of hepatitis B virus - related acute - on - chronic liver failure （ HBV - ACLF） patients. Methods One - hundred - and - twelve patients with HBV - ACLF treated in our hospital from January 2009 to June 2011 were enrolled for study. The patients were assigned to the antiviral therapy group （standard therapy plus nucleoside analogue, n = 58） or the control group （standard therapy, n = 54）. The clinical features, survival rate, and short - term efficacy of antiviral therapy were comparatively analyzed between the two groups using the Chi - square test. The relation of prognostic factors was determined by logistic regression analysis. Results After four weeks of treatment, alanine aminotransferase was de- creased and chofinesterase was improved significantly in each group （ P 〈 0.05 ）. After eight weeks of treatment, total bilirubin and MELD score were lower and prothrombin activity was higher in the antiviral therapy group than in the control group （ P 〈 0.05 ）. After four weeks of treatment, the HBV DNA - negative rate was higher in the antiviral therapy group （ P 〈 0.05 ）. After 90 days of treatment, the survival rate was significantly higher in the antiviral treatment group （ P = 0. 025 ）. Hepatitis B virus e antigen （ HBeAg ） , hepatic encephalopathy （HE）, hepatorenal syndrome （HRS） , and antiviral therapy were identified as prognostic factors of HBV - ACLF. Conclusion Antiviral therapy has a strong beneficial effect on the prognosis of HBV - ACLF patients by improving the 90 - day survival rate. HBeAg - negative status and presence of HE or HRS are associated with lower 90 - day survival rate.

关 键 词：肝功能衰竭 急性 肝炎病毒 乙型 抗病毒药 

分 类 号：R512.91[医药卫生—内科学]