新型简易评分系统判定恩替卡韦在乙型肝炎慢加急性肝衰竭中治疗时机与疗效  

A new simple scoring system to determine the timing and efficacy of entecavir therapy in hepatitis B-related acute-on-chronic liver failure

作　　者：厉新妍[1] 雷瑞祥[2] Li Xinyan;Lei Ruixiang(Department of Infectious Diseases,Guangzhou First Municipal People's Hospital,Guangzhou 510180, China;Department of Infectious Diseases,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]广州市第一人民医院感染科,广州510180 [2]中山大学附属第三医院感染科,广州510630

出　　处：《中华医学杂志》2019年第4期291-294,共4页National Medical Journal of China

摘　　要：目的应用新型简易评分系统,判定恩替卡韦(ETV)在乙型肝炎慢加急性肝衰竭(ACLF)的治疗时机与疗效。方法对212例乙型肝炎ACLF患者在内科常规治疗基础上加用恩替卡韦0.5mg/d抗病毒治疗。应用乙型肝炎ACLF预后评分模型对患者病情严重度进行评分,记录在开始治疗时、存活出院时/临终前的肝衰竭严重性评分、乙型肝炎病毒脱氧核糖核酸(HBVDNA)载量、住院时间。结果按照百分位统计表,对入院评分进行分组。确定≤4分为低分组,5-7分为中低分组,8-11分为中高分组,≥12分为高分组。随着分数的增高,死亡率上升,各组间比较差异有统计学意义(χ^2=310.662,P<0.001)。各组入院与死亡/出院严重度评分,低分组评分比较差异有统计学意义(P=0.003)。使用ETV在入院和死亡/出院时HBVDNA载量的比较,低分、中低分、中高分组差异有统计学意义(P<0.000)。中低分组和中高分组使用ETV死亡和存活病人入院和死亡时HBVDNA载量比较差异无统计学意义。结论ETV对HBV-ACLF的挽救治疗疗效与开始用药时ACLF的严重性相关,HBV-ACLF预后评分系统可以比较清晰的判定ETV治疗HBV-ACLF的时机与疗效。Objective To determine the timing and efficacy of entecavir (ETV) therapy in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) using a new simple scoring system. Methods A total of 212 patients with HBV-ACLF were treated with ETV 0.5 mg daily besides the routine treatment. The severity of illness was scored by the HBV-ACLF prognostic scoring system. Hepatic failure severity scores, hepatitis B virus DNA (HBV DNA) load, and length of hospital stay were recorded at the time of initiation of treatment, and the time of survival to hospital discharge/end of life. Results Patiens were divided into four groups by the admission severity scores according to the percentile table: low score group (score≤ 4), medium-low score group (score: 5-7), medium-high score group (score: 8-11), and high score group (score ≥12). As the scores increased, the mortality rate increased. There were significant differences among different groups (χ^2=310.662, P<0.001). There were significant difference of the admission and discharge/death severity scores in the low score group (P=0.003). There were significant differences of the comparison of HBV DNA load at admission and death/discharge using ETV in low-, medium-low, and medium-high score groups (P<0.001). There were no significant differences of HBV DNA load at admission and death/discharge using ETV for dead and survival patients in the medium-low, and medium-high score groups. Conclusions The efficacy of ETV in the rescue treatment of HBV-ACLF is related to the severity of ACLF when starting medication. The HBV-ACLF prognostic scoring system can clearly determine the timing and efficacy of ETV treatment of HBV-ACLF.

关 键 词：乙型肝炎 慢加急性肝衰竭 恩替卡韦 乙型肝炎病毒脱氧核糖核酸 

分 类 号：R512.62[医药卫生—内科学]