乙型肝炎后肝硬化失代偿期患者自然病程进展与血清乙肝病毒复制载量关系的研究  

Natural Disease Progression of Hepatitis B-related Decompensated Cirrhosis: Focus on Relationship between Serum Hepatitis B Virus Load and Disease Progression

作　　者：李淑婷[1] 高婷[1] 杨淑殷[1] 沈黎蔚[1] 周婷婷[1] 董小君[1] 曾菠[1] 李海[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科 上海市消化疾病研究所,200001

出　　处：《胃肠病学》2013年第9期516-520,共5页Chinese Journal of Gastroenterology

基　　金：国家自然基金面上项目(30770962;30971333;81170421)

摘　　要：背景:乙型肝炎后肝硬化失代偿期患者血清HBV-DNA载量水平与自然病程生存率关系的研究甚少。目的:研究血清HBV-DNA载量水平对乙型肝炎后肝硬化失代偿期患者自然病程的影响并评估3年生存的影响因素。方法:连续纳入2005年1月～2010年12月上海仁济医院乙型肝炎后肝硬化失代偿期患者,以HBV-DNA载量水平<1000、103～104、104～105、105～106、>106copies/mL分为A～E 5个队列,收集各项实验室检查结果,行肝功能评分,随访至终点事件发生或研究终点(2012年2月29日)。采用Kaplan-Meier法计算累积生存率,单因素分析和多因素COX回归分析明确3年生存风险的独立影响因素。结果:依纳入排除标准共收入连续病例257例,中位Child-Pugh评分10(8,12)分,MELD评分14(11,18)分。A～E组之间人口学、生化、临床基线数据相比差异基本无统计学意义,6个月累积生存率分别为74.7%、81.2%、60.7%、76.5%和71.3%(P=0.318),3年累积生存率依次为50.8%、52.4%、39.1%、44.2%和34.9%(P=0.230),差异均无统计学意义。单因素分析显示HBV-DNA载量水平与乙型肝炎后肝硬化失代偿期患者3年生存无关(P>0.05),多因素COX回归分析示年龄、肝性脑病、INR、总胆红素、血肌酐为其独立危险因素,白蛋白和血清钠为保护因素。结论:血清基线HBV-DNA载量水平并不是乙型肝炎后肝硬化失代偿期患者自然进展死亡的独立危险因素。Background： Studies on the relationship between natural disease progression of hepatitis B-related decompensated cirrhosis and serum HBV-DNA load are quite rare. Aims： To evaluate the prognostic significance of HBV-DNA load in patients with hepatitis B-related decompensated cirrhosis, and to investigate the risk factors for 3-year survival. Methods： Consecutive patients with hepatitis B-related decompensated cirrhosis from Jan. 2005 to Dec. 2010 at Shanghai Renji Hospital were enrolled and divided into 5 groups （group A-E） according to HBV-DNA load （〈1000, 103-104, 104-105, 105-106, 〉106 copies/mL）. Results of laboratory examination were collected and hepatic function was scored. All patients were followed up to death or the cut-off date of Feb. 29, 2012. Cumulative survival rate was calculated by Kaplan-Meier assay, and risk factors for 3-year survival were determined by univariate analysis and COX regression analysis. Results： Two hundred and fifty-seven patients were enrolled. Child-Pugh score and MELD score were 10 （8,12） and 14 （11,18）, respectively. No significant differences in demographic, biochemical and clinical data were found among the 5 groups. The 6-month and 3-year cumulative survival rates for 5 groups were 74.7%, 81.2%, 60.7%, 76.5%, 71.3% （P=0.318） and 50.8%, 52.4%, 39.1%, 44.2%, 34.9% （P=0.230）, respectively. Univariate analysis showed that HBV-DNA load was not correlated with 3-year survival of hepatitis B-related decompensated cirrhosis, and COX regression analysis showed that age, hepatic encephalopathy, INR, total bilirubin, creatinine were the independent risk factors, and albumin, sodium were the protective factors for 3-year survival. Conclusions： Serum HBV-DNA load is not an important and independent risk factor for natural disease progression in hepatitis B-related decompensated cirrhosis patients.

关 键 词：肝硬化失代偿期 乙型肝炎病毒 病毒载量 危险因素 

分 类 号：R575.2[医药卫生—消化系统]