核苷(酸)类似物抗病毒治疗对早期乙型肝炎病毒相关性慢加急性肝衰竭患者预后的影响  

Effect of antiviral therapy with nucleot( s) ides analogues on prognosis of patients at early-stage of hepatitis B virus-related acute-on-chronic liver failure

作　　者：刘慧敏[1] 张绪清[1] 郭艳[1] 刘明[1] 毛青[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,感染病研究重庆市重点实验室,400038

出　　处：《第三军医大学学报》2017年第24期2412-2417,共6页Journal of Third Military Medical University

基　　金：国家科技重大专项(2017ZX10203201-006);第三军医大学临床科研重大专项(2012XLCO5);国家临床重点专科建设项目[中国人民解放军总后勤部卫生部(卫医疗[2013]147号)]~~

摘　　要：目的探讨核苷(酸)类似物[nucleot(s)ides analogues,NAs]抗病毒治疗对早期乙型肝炎病毒相关性慢加急性肝衰竭(hepatitis B virus associated acute-on-chronic liver failure,HBV-ACLF)预后的影响。方法收集2002年1月至2012年12月第三军医大学西南医院感染病研究所住院的早期HBV-ACLF患者618例,其中男性568例,女性50例,年龄12~77(41.29±11.38)岁。根据有无联合NAs抗病毒治疗将患者分为抗病毒组(546例)和对照组(72例)。采用多因素COX回归分析NAs抗病毒治疗对早期HBV-ACLF患者预后的影响。回顾性分析比较基线特征和治疗6个月后的自然生存率。结果多因素COX回归分析表明是否抗病毒治疗、性别、年龄、血浆Na+浓度、血清总胆红素和白细胞是影响早期HBV-ACLF患者预后的独立影响因素。抗病毒组的自然生存率显著高于对照组(52.0%vs36.1%,P<0.05)。不同抗病毒方案的自然生存率依次为:恩替卡韦(56.4%)>拉米夫定联合阿德福韦酯(55.2%)>拉米夫定(50.8%),差异无统计学意义(P>0.05)。结论早期HBV-ACLF患者使用NAs抗病毒治疗可提高自然生存率。Objective To evaluate the effect of antiviral therapy with nucleot（s）idesanalogues （NAs） on the prognosis of patients with early-stage hepatitis Bvirus-related acute-on-chronic liver failure （HBV-ACLF）. MethodsAretrospective analysis was performed of 618 patients with early-stageHBV-ACLF, including 568 males and 50 females, aged from 12 to 77（41.29±11.38） years, who were hospitalized in our institute from January 2002to December 2012. According to receiving NAs treatment or not, they weredivided into antiviral group （n=546） and control group （n=72）. Multivariate COXregression analysis was carried out to identify independent influential factorsrelated to prognosis of these patients. The baseline characteristics andnatural survival rate in 6 months after treatment were analyzed. ResultsMultivariate regression analysis identified antiviral therapy, sex, age,plasma Na＋ concentration, total serum bilirubin and white blood cell count wereindependent factors for the prognosis of these patients. The patients withantiviral therapy had a higher natural survival rate then the control （52.0% vs36.1%, P〈0.05）. The natural survival rate of the patients receiving entecavir,lamivudine combined with adefovir, and dipivoxil were 56.4%, 55.2%, and 50.8%in turn. No significant difference was observed among the patients treated withdifferent types of NAs （P〉0.05）. Conclusion NAs treatment significantly increasethe 180-day natural survival rate for the patients with early-stage HBV-ACLF.

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 核苷(酸)类似物 抗病毒 预后 

分 类 号：R512.62[医药卫生—内科学] R575.305[医药卫生—临床医学]