核苷酸类药物治疗乙型肝炎病毒感染导致的慢加急性肝衰竭患者疗效分析  

Efficacy of nucleos (t)ide analogs in treatment of patients with hepatitis B acute-on-chronic liver failure

作　　者：付喜花 张振华[2] 刘婉婷 娄海波 黄明寿 吴文斌 陈金军[3] 

机构地区：[1]广州市番禺区中心医院感染性疾病科,511400 [2]安徽医科大学第一附属医院感染性疾病科 [3]南方医科大学南方医院感染性疾病科

出　　处：《实用肝脏病杂志》2017年第1期69-72,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(81470038);广州市医药卫生科技资助项目(20141A011109)

摘　　要：目的观察核苷酸类药物治疗慢性乙型肝炎导致的慢加急性肝衰竭(ACLF)患者的临床疗效。方法在慢性乙型肝炎导致的ACLF患者178例中,115例在内科基础治疗的基础上给予核苷(酸)类药物口服,63例对照组只接受内科基础治疗。采用实时荧光定量PCR法检测血清HBV DNA,使用美国Beckman全自动生物化学分析仪检测生化指标;使用德国美创MC-2000血凝仪检测血浆凝血酶原时间等凝血指标。根据公式计算终末期肝病模型(MELD)评分。结果在治疗24 w时,抗病毒组生存率(65.2%)显著高于对照组(39.7%,P<0.05);抗病毒组生存患者外周血白细胞(WBC)、中性粒细胞(NEU)、血小板(PLT)、血红蛋白(HGB)和纤维蛋白原(Fbg)分别为(7.2±1.6)×109/L、(5.1±2.7)×109/L、(131.4±50.3)×109/L、(143.7±14.5)g/L和(2.0±0.6)g/L,均显著高于对照组的【(4.4±3.6)×109/L、(2.6±3.3)×109/L、(96.2±53.3)×109/L、(116.5±24.4)g/L和(1.3±0.5)g/L,P<0.01】;抗病毒组生存患者凝血酶原时间(PT)和国际标准化比值(INR)分别为(15.5±4.4)s和(1.3±0.5),显著低于对照组[分别为(24.2±10.2)s和(2.0±1.5),P<0.01]。结论抗病毒治疗能改善慢性乙型肝炎导致的ACLF患者凝血功能,提高生存率。Objective To observe the efficacy of antiviral therapy with nucleos（t）ide analogs in patients with hepatitis B acute-on-chronic liver failure （ACLF）. Methods A total of 178 patients with ACLF induced by hepatitis B viral infection were divided into antiviral group（n=115） and control group（n=63）. The patients in antiviral group were given nucleos（t）ide analogs at the base of symptomatic and supporting treatment, and in the control group were not given antiviral therapy. Serum HBV DNA was assayed by PCR,and the model of end-stage liver disease（MELD） was calculated. Results At the end of 24 weeks observation,the survival rate in the antiviral group was 65.2%,much higher than in the control group（39.7%,P〈0.05）;the white blood cell counts,neutrophils,platelets,hemoglobin and fibrinogen levels in survival patients receiving antiviral treatment were（7.2±1.6）×10^9/L,（5.1±2.7） ×10^9/L,（131.4±50.3）×10^9/L,（143.7±14.5） g/L and（2.0±0.6） g/L,much higher than those in control group [（4.4±3.6）×10^9/L,（2.6±3.3）×10^9/L,（96.2±53.3）×10^9/L,（116.5±24.4） g/L and （1.3±0.5）g/L,P〈0.01]; the prothrombin time and international normalized ratio in antiviral group were（15.5±4.4） s and（1.3±0.5）,respectively,significantly lower than those in control group[（24.2±10.2） s and（2.0±1.5）,P〈0.01]. Conclusion Antiviral therapy can improve the coagulation function index,peripheral blood cell counts,and the survival rate of patients with ACLF.

关 键 词：乙型肝炎 慢加急性肝衰竭 核苷(酸)类 生存率 

分 类 号：R512.62[医药卫生—内科学]