拉米夫定治疗慢性乙型肝炎引起的慢加急性肝衰竭患者临床疗效评价  

Clinical efficacy of lamivudine on patients with early-to-mid stage Hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)

作　　者：詹乐强 咸建春[2] 

机构地区：[1]浙江省丽水市缙云县人民医院感染科,浙江缙云321400 [2]江苏省泰州市人民医院肝病科,江苏泰州225300

出　　处：《中国现代医生》2014年第13期35-38,共4页China Modern Doctor

基　　金：江苏省卫生厅面上科研课题(H201059)

摘　　要：目的探讨拉米夫定治疗慢性乙型肝炎引起的慢性和急性肝衰竭的临床疗效。方法回顾性分析我院于2009年4月～2011年8月收治的50例接受拉米夫定治疗的慢性乙型肝炎引起的慢性和急性肝衰竭患者的临床资料，对比分析所有生存患者中治疗期间不同时间点肝功能与MELD评分。根据所有患者对药物的反应将其分为部分病毒应答组与完全病毒应答组，并比较两组在治疗期间不同时间点的肝功能与MELD评分。结果治疗8周后，共8例患者死亡，生存率84．0％，所有患者的平均生存时间为（6．0＋0．9）周；治疗24周后，共11例患者死亡，生存率78．0％，所有患者的平均生存时间为（12．8＋2．9）周。治疗8周及24周之后，所有生存患者PTA、ALT、AST、TBil、Alb、HBVDNA拷贝量及MELD评分较治疗前有明显改善（P〈O．05）；治疗8周时，部分应答组与完全应答组PTA、ALT、AST、TBil、Alb及MELD评分的差异比较无统计学意义（P〉0．05），而治疗24周后，完全应答组上述指标明显优于部分应答组（P〈0．05）。结论拉米夫定治疗乙型肝炎慢加急性肝衰竭的临床疗效良好。而病毒学应答较好的患者肝功能的改善情况更为显著。Objective To investigate the clinical efficacy of lamivudine on patients with early-to-mid stage Hepatitis B virus related acute-on-chronic liver failure （HBV-ACLF）. Methods Fifty lamivudinc on patients with early-to-mid stage Hepatitis B virus related acute-on-chronic liver failure （HBV-ACLF） who were treated in our hospital from April 2009 to August 2011 were retrospectively analyzed. They were divided into the partial virological response and the complete virological response group according to all the response of patients to drugs,the liver function and MELD scores at different time point during the treatment were compared. Results After eight weeks treatment, eight cases of patients died, the survival rate was 84.0%, the average survival time for all patients was （6.0~0.9）weeks;after twenty- four weeks treatment,eleven cases patients died, the survival rate was 78.0%, the average survival time for all patients was（12.8＋2.9） weeks. After eight weeks and twenty-four weeks of treatment, the PTA, ALT, AST, TBil, propagated, HBV DNA copies and MELD score of all survival patients were significantly improved than that of before treatment （P〈0.OS）;After eight weeks treatment,PTA, ALT, AST, TBil, propagated and MELD score of two groups was no significantly different（P〉0.05）, and after twenty-four weeks treatment, the PTA, ALT, AST, TBil, propagated, HBV DNA copies and MELD score was obviously better in the fully response group than that of part of the response group （P〈0.05）. Conclusion The clinical efficacy of lamivudine on patients with early-to-mid stage Hepatitis B virus related acute-on-chronic liver failure （HBV-ACLF） is sure,and virological response in patients with good liver function improvement is more significant.

关 键 词：拉米夫定 乙型肝炎 慢加急性肝功能衰竭 临床疗效 

分 类 号：R512.62[医药卫生—内科学]