替诺福韦酯治疗HBV耐药相关的慢加急性肝功能衰竭的短期疗效观察  

Observation on the short-term therapeutic effect of tenofovir disoproxil fumarate in treatment of 5 cases with acute on chronic liver failure induced by mutant hepatitis B virus

作　　者：张馨[1] 李平[1] 高蕾[1] 熊熙[1] 王耀峰[1] 张玥[1] 张晓凤[1] 汪茂荣[1] 张馨 李平[1] 高蕾[1] 熊熙[1] 王耀峰[1] 张玥[1] 张晓凤[1] 汪茂荣[1] 

机构地区：[1]解放军第81医院全军肝病中心,南京市210002

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第1期6-9,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家科技重大专项课题(No.2008ZX10002-005-6)

摘　　要：目的观察替诺福韦酯(TDF)治疗HBV耐药相关的慢加急性肝功能衰竭(ACLF)患者的短期疗效。方法回顾性观察5例HBV耐药相关的ACLF患者经TDF单药或联合治疗后病毒学应答、免疫学应答情况及肝功能指标、终末期肝病模型(MELD)评分的变化。结果 5例患者接受TDF抗病毒治疗2、4周后HBV DNA复制水平均较治疗前显著下降,4例患者于8周后均达到HBV DNA<500拷贝/ml;1例患者治疗12周时HBV DNA<500拷贝/ml,该患者在治疗第8周发生HBe Ag/HBe Ab转换;4例患者主要肝功能指标及MELD评分较治疗前明显改善。结论 TDF能有效地降低ACLF患者耐药HBV DNA的复制,可能有利于提高肝功能衰竭患者的生存率。Objective To investigate the short-term therapeutic effect of tenofovir disoproxil fumarate （TDF） in treatment of 5 cases with acute on chronic liver failure （ACLF） induced by mutant hepatitis B virus. Methods Clinical data of 5 cases with ACLF induced by HBV were analyzed, retrospectively, and they were given TDF 300 mg/d orally. The levels of drug resistance mutation, serum ALT, serum TBil, serum creatinine, serum INR, HBeAg/HBeAb quantiifcation and HBV DNA of those patients were analyzed, respectively. Results Two and four weeks after treatment, the HBV DNA replications of 5 cases were suppressed. Eight weeks after the treatment, the HBV DNA replications of 4 cases were undetected. The HBV DNA replication of the rest case was undetected at 12 weeks after the treatment, and the HBeAg/HBeAb seroconversion appeared in this case at 8 weeks after the treatment. The liver function and model for end-stage liver disease （MELD） score of 4 cases were improved after TDF combined with routine treatment. Conclusions TDF in treatment of acute on chronic liver failure induced by mutant hepatitis B virus could achieve a rapidly response, which might improve the survival rate.

关 键 词：肝炎病毒 乙型 替诺福韦酯 肝功能衰竭 预后 

分 类 号：R969[医药卫生—药理学]