恩替卡韦治疗46例HBV相关慢加急性肝衰竭临床分析  

Efficacy of entecavir for treating 46 cases with hepatitis B virus related acute on chronic liver failure

作　　者：刘必铿[1] 高海兵[2] 林太杰[2] 林明华[2] 

机构地区：[1]福建医科大学附属第一医院药学部,福州350003 [2]福州市传染病医院肝内科

出　　处：《肝脏》2015年第6期438-442,共5页Chinese Hepatology

摘　　要：目的探讨影响HBV-ACLF病情转归的危险因素及恩替卡韦治疗HBV-ACLF的效果。方法在基础治疗前提下加用恩替卡韦治疗46例HBV-ACLF患者,观察并比较患者生物化学指标、HBV DNA载量、并发症、MELD评分、有无肝硬化基础及患者1、3、6、12和24个月内生存情况,分析影响患者病情转归的危险因素。结果治疗1个月患者病死率为15.2%,PTA是影响转归的危险因素,生存组PTA为34.4±4.7,死亡组PTA为24.2±10.9,差异有统计学意义(P=0.049);治疗3个月患者病死率增加为21.7%,PTA和MELD评分是影响转归的危险因素。生存组PTA为35.0±4.2,死亡组PTA为25.1±9.2,差异有统计学意义(P=0.008);生存组MELD评分为22.2±3.5,死亡组MELD评分为29.1±7.7,差异有统计学意义(P=0.021);治疗6个月至24个月患者病死率增加为28.3%;MELD评分是影响转归的危险因素,生存组MELD评分为22.2±3.6,死亡组MELD评分为27.7±7.2,两组差异有统计学意义(P=0.019)。结论在基础治疗前提下加用恩替卡韦治疗HBV-ACLF,治疗3个月内患者病情转归的判断主要依赖PTA的结果;而治疗3个月后MELD评分对病情转归的判断更为可靠。Objective To investigate the efficacy of entecavir in treating hepatitis B virus related acute on chronic liver failure （HBV‐ACLF） ,and analyze the risk factors associated with the prognoses of HBV‐ACLF .Methods Forty‐six patients with HBV‐ACLF received administration of entecavir under the premise of basic treatment .The following aspects were evaluated to analyze the risk factors associated with the outcome of HBV‐ACLF ,including biochemical indices ,HBV DNA loading ,complications ,model for end‐stage liver disease （MELD） score ,presence or absence of hepatic cirrhosis ,and the survival rate at month 1 ,3 ,6 ,12 and mo 24 ,respectively .Results The mortality rate was 15 .2% at month 1 ,and prothrombin time activity（PTA） was the risk factor for the outcome of HBV‐ACLF .Significant increase was noticed in the PTA of survival group compared with that of death group （34 .4 ± 4 .7 vs .24 .2 ± 10 .9 ,P=0 .049） .A mortality rate of 21 . 7% was observed at mo 3 ,and the PTA and MELD score were the risk factors for the outcome of HBV‐ACLF .Remarkable increase was noted in the PTA of the survive group compared with that of the death group （35 .0 ± 4 .2 vs .25 .1 ± 9 .2 ,P=0 .008） .In addition ,the MELD score showed significant decrease in the survive group compared with that in the death group （22 .2 ± 3 .5 vs .29 .1 ± 7 .7 ,P=0 .021） .After 6‐24 months treatment ,the mortality rate rose to 28 .3% ,and the MELD score was the risk factor for the progression of HBV‐ACLF .Compared with that in the survive group ,the MELD score showed remarkable increase in the death group （27 .7 ± 7 .2 vs .22 .2 ± 3 .6 ,P=0 .019） .Conclusion For the patients received basic treatment plus entecavir ,PTA level is the main factor to evaluate the outcome of HBV‐ACLF within 3 months after treatment ,while the MELD score is reliable indicator for prognosis after 3 months treatment .

关 键 词：HBV 肝衰竭 恩替卡韦 疗效 

分 类 号：R512.62[医药卫生—内科学]