长期抗病毒治疗对乙型肝炎肝硬化患者预后及转归影响  

The Effects of Long-term Antiviral Therapy on the Prognosis of patients with Hepatitis B-induced Cirrhosis

作　　者：鲁晓擘[1] 沙尼亚.尼亚孜 甄作睿[1] 李纲[2] 张泽高[1] 张跃新[1] 

机构地区：[1]新疆医科大学第一附属医院感染性疾病中心,乌鲁木齐830054 [2]武警新疆总队医院感染科

出　　处：《肝脏》2013年第9期591-595,共5页Chinese Hepatology

基　　金：十一五国家传染病重大专项(编号2008ZX10002-005-3)

摘　　要：目的探讨长期抗病毒治疗对乙型肝炎肝硬化患者的预后及转归影响。方法收集新疆医科大学第一附属医院感染科2007年至2011年期间238例乙型肝炎肝硬化患者临床资料，建立数据库，并行回顾性分析。治疗组（抗病毒组）160例，对照组（未抗病毒组）78例。治疗组使用拉米夫定、阿德福韦酯、替比夫定、恩替卡韦单药或联合抗病毒治疗，疗程3年～7年，平均疗程50个月。所有肝硬化患者均行保肝、抗纤维化、纠正肝功能等内科综合治疗。评价指标：抗病毒治疗能否改善肝功能（Child—Turcotte—Pugh，CTP评分）、减少肝硬化病死率、提高生存率；抗病毒治疗能否减少肝癌发生率。两组生存曲线比较采用Log—rank检验（检验标准a=0．05）；预后采用KaplanMeier法（Log—rank检验）进行单因素分析。结果治疗组中位生存时间为38．7个月，12、24、50个月生存率为74．4％、64．4％、41．9％；对照组中位生存时间为30．9个月，12、24、50个月生存率为67．9％、53．80,4、39．7％，差异有统计学意义（x2=9．350，P〈0．05）。治疗组患者行50个月的治疗观察，预后分析结果提示HBVDNA、ALT、PTA、CTP评分、是否抗病毒治疗影响肝硬化患者预后比较差异有统计学意义（P〈O．05）。治疗组与对照组患者12、24、50个月累计病死率分别为25．6％、35．6％、58．1％及32．1％、46．2％、60．3％，差异有统计学意义（P〈O．05）；累计肝癌发生率分别为6．4％、12．5％、23．170及10．3％、16．7％、26．8％，差异有统计学意义（P％0．05）。结论乙型肝炎肝硬化患者短期抗病毒治疗受益可能不大，长期规范化抗病毒治疗可降低肝硬化患者病死率，降低肝癌发生率。Objective To investigate the effects of long-term antiviral therapy on the prognosis of patients with hepatitis B virus （HBV）-induced Cirrhosis. Methods The database was established, which contained 237 patients with HBV-induced hepatic cirrhosis who accepted treatment in the First Affiliated Hospital of Xinjiang Medical University from 2007 to 2011, and a review analysis was performed on these data. One hundred and sixty cases who accepted antiviral therapy were enrolled as treatment group and 78 cases without antiviral therapy were enrolled as control group . The patients in treatment group were given mono-therapy or combination therapy, including lamivudine, adefovir dipivoxil, telbivudine or entecavir, with a diverse course 3-7 years （average duration of treatment was 50 months）. Meanwhile, all cases were accepted systematic medical treatment, such as anti-fibrosis, against liver function abnormal. Child-Turcotte-Pugh （CTP） scores, mortality and occurrence of HCC were the key evaluation parameters. Survival curves of two groups were compared using Log-rank test （test a = 0.05）; Kaplan Meier method （Log-rank test） was adopted in prognosis for univariate analysis. Results The treatment group had a median survival time of 38.7 months, survival rates of 12, 24 and 50 months were 74.4%, 64.4% and 41.9%, respectively. While median survival time of control group was 30. 9 months, and survival rates of 12, 24 and 50 months were 67. 9%, 53. 8% and 39. 7%, respectively. The survival curves had a signifcant difference between two groups when Log-rank test was performed （2 =9. 350,P〈0. 05）. The prognosis analysis results showed that HBV DNA, alanine aminotransferase （ALT）, prothrombin activity （PTA）%, CTP score and the usage of antivirus drugs had evident correlations with disease prognosis. The accumulative survival rates of 12, 24 and 50 months of patients in treatment groupe, which were 25.6%, 35.6% and 58. 1%, respectively, were obviously lower than those in control group which were

关 键 词：乙型肝炎病毒 肝硬化 核苷(酸)类似物 抗病毒治疗 生存 

分 类 号：R512.62[医药卫生—内科学]