乙型肝炎肝硬化失代偿患者核苷类抗病毒治疗的长期疗效  

Effects of oral antiviral agents on long-term outcomes of treatment-na（i）ve patients with HBV-related decompensated cirrhosis： a retrospective cohort study

作　　者：胡沛[1] 赵钢德[1] 李海[2] 高婷[2] 李淑婷[2] 汤伟亮[1] 周惠娟[1] 王晖[1] 谢青[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025 [2]上海交通大学医学院附属仁济医院消化病研究所

出　　处：《中华肝脏病杂志》2014年第11期806-811,共6页Chinese Journal of Hepatology

基　　金：国家自然科学基金（81171569）;上海市科委优秀学术带头人项目（12XDl403600）;国家“十二五”科技重大专项（2012ZXl0002007-002-003,2012ZXl0002004-003,2012ZXl0002003-005-013）

摘　　要：目的 在综合治疗的基础上,通过抗病毒治疗组与非抗病毒治疗对照组的对比,了解核苷（酸）类抗病毒药物对乙型肝炎肝硬化失代偿患者的肝脏功能及远期生存率的影响. 方法 收集2005年至2009年住院治疗的乙型肝炎肝硬化失代偿患者,依据纳入及排除标准,进入回顾性研究队列进行疗效和生存分析.并对选用不同抗病毒药物的患者进行分组分析,依据患者MELD评分对患者进行分层.重点关注19例治疗满5年的患者,比较其治疗前后的生物化学及病毒学指标,了解长期抗病毒治疗对患者肝功能及长期生存的改善情况.正态分布数据两组均数比较用t检验,多组均数比较用单因素方差分析;分类数据用x2检验及Fisher精确概率法;用Kaplan-Meier法计算生存率及绘制生存曲线,MELD评分分层后各组间的比较采用Log-rank对数秩检验. 结果 最终入组166例,其中抗病毒治疗组114例,对照组52例.生存分析结果显示,抗病毒治疗组5年累计生存率显著高于对照组（74.1％对比34.9％,x 2=25.738,P＜0.001）.当患者MELD评分＜18分时,抗病毒治疗可以显著改善患者生存率（x2=16.034,P＜0.001）.对病情较重（MELD评分≥18分）的患者,抗病毒治疗组与对照组3个月累积生存率差异无统计学意义（43.8％对比58.4％,x2=3.224,P=0.073）.19例治疗满5年患者治疗前后ALT、白蛋白、总胆红素、凝血酶原时间、肌酐及血小板计数差异均有统计学意义（P值均＜ 0.05）;治疗前19例患者的HBV DNA均＞103拷贝/ml,治疗后仅1例患者HBV DNA＞103拷贝/ml,差异有统计学意义（Fisher精确检验,P＜ 0.05）;治疗前后的CTP评分分别为（8.78＆#177;1.65）分和（6.00＆#177;1.29）分,差异有统计学意义（t=6.596,P＜0.01）. 结论 抗病毒治疗可以显著改善乙型肝炎肝硬化失代偿患者的预后及长期生存率,早期应用患者获益更多.对病情较重并发症较多患者,尽管抗病毒治疗短�Objective To evaluate the efficacy ofnucleos（t）ide analogues （NA） treatment and to assess the long-term outcomes,including survival,liver function improvement and virologic response,in patients with decompensated cirrhosis due to hepatitis B virus （HBV） infection.Methods Patients with ChildTurcotte-Pugh （CTP） scores ≥ 7,who had been treated with either lamivudine or other agents,but who were free of co-infection with other hepatitis virus were enrolled between January 2005 and December 2009.The study participants were subgrouped according to the antiviral drugs received or model for endstage liver disease （MELD） score for comparative analyses.Additionally,the 19 patients who were treated with NA for more than 5 years were investigated for changes in biochemical and virological indices,before and after the antiviral treatment.Results A total of 166 patients （125 males; 89 e-negative） and 52 untreated healthy patients （as control） were analyzed.The cohort of patients receiving antiviral therapy had significantly better 5-year actuarial survival than the untreated patients （74.1% vs.34.9%,P 〈 0.001）.For patients with MELD score ≥ 18,actuarial survival was not significantly different between the two groups （P =0.073）.Conclusion Antiviral therapy significantly increases survival and improves the clinical long-term outcome of patients with HBV-induced decompensated cirrhosis.Antiviral treatment should be initiated at an early stage to maximize benefit in the improvement of clinical status.

关 键 词：肝炎 乙型 肝硬化 失代偿 抗病毒治疗 生存分析 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]