长期抗病毒治疗对Child-Pugh B级和C级乙型肝炎肝硬化失代偿期患者生存率的影响  

The research on the effect of long-term antiviral therapy on the survival rate of patients with Child-Pugh level B and level C hepatitis B liver cirrhosis at decompensated stage

作　　者：刘坤[1] 赵培利[1] 李艳静[1] 赵俊梅[1] 段银环[1] 王守云[1] LIU Kun;ZHAO Pei-li;LI Yan-jing;WANG Shou-yun(Department of Traditional Chinese Medicine and Western Medicine,No.3 Hospital of Qinhuangdao(Qinhuangdao Hebei,066000)China)

机构地区：[1]秦皇岛市第三医院中西医肝病科,河北秦皇岛066000

出　　处：《中西医结合肝病杂志》2022年第4期311-314,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：河北省2020年度医学科学研究课题计划(No.201805A158)。

摘　　要：目的:探讨长期抗病毒治疗对Child-Pugh B级和C级乙型肝炎肝硬化失代偿期患者生存率的影响。方法:选取2011年1月至2016年1月秦皇岛市第三医院收治的200例乙型肝炎肝硬化失代偿期患者作为研究对象,根据Child-Pugh分级分为B级组(100例)和C级组(100例),所有患者给予抗病毒治疗,随访5年,比较两组患者肝功能及凝血指标、肝纤维化指标、乙型肝炎病毒(HBV DNA)定量及Child-Pugh评分、生存率情况。结果:随访结束时,两组患者的白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、天门冬氨酸氨基转移酶(AST)、胆碱酯酶(CHE)及凝血酶原时间(PT)等肝功能指标与凝血指标水平均较治疗前显著改善(P<0.05)。其中,两组患者Alb、ALT及PT水平治疗后差异无统计学意义(P>0.05),TBil、AST及CHE等指标水平差异有统计学意义(P<0.05);透明质酸酶(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)等指标水平均较治疗前显著改善(P<0.05);两组患者的HBV DNA定量及Child-Pugh评分均较治疗前显著改善(P<0.05);B级组5年累积生存率为71.28%,显著高于C组的55.64%(P=0.016)。结论:Child-Pugh B级和C级乙型肝炎肝硬化失代偿期患者经过长期抗病毒治疗,其5年累积生存率均能超过50%,Child-Pugh分级较差组经长期抗病毒治疗后也能够获得多项指标的获益。Objective:To investigate the effect of long-term antiviral therapy on the survival rate of patients with Child-Pugh level B and level C hepatitis B liver cirrhosis at decompensated stage.Methods:Select 200 patients with hepatitis B and liver cirrhosis who were admitted to the Department of Liver Diseases and Infectious Diseases of Qinhuangdao Third Hospital from January 2011 to January 2016 as the research objects.According to the level of Child-Pugh, they were divided into level B group(100 cases) and level C group(100 cases).All patients were given antiviral therapy, with five years of follow-up.The liver function, blood coagulation indexes, liver fibrosis index, the hepatitis B virus(HBV) DNA quantitative, Child-Pugh scores and the situation of survival rate of the two groups were compared. Results:At the end of follow-up, albumin(ALB),alanine aminotransferase(ALT), total bilirubin(TBil), aspartate aminotransferase(AST), cholinesterase(CHE),prothrombin time(PT) and other liver function indexes levels and coagulation indexes levels in the two groups were significantly improved compared with those before the treatment(P<0.05);Among them, the differences of ALB,ALT and PT levels between the two groups after the treatment were not statistically significant(P>0.05),while the differences of TBIL,AST and CHE levels were still significant(P<0.05);Hyaluronidase(HA),procollagen typeⅢ(PCⅢ),collagen typeⅣ(C-Ⅳ) and other indexes in the two groups were significantly improved compared with those before the treatment(P<0.05),and the differences of liver fibrosis indexes between the two groups were still significant(P<0.05);HBV DNA quantitative and Child-Pugh scores in the two groups were significantly improved compared with those before the treatment(P<0.05),and the differences in HBV DNA quantitative level and Child-Pugh scores between the two groups were still significant(P< 0. 05);The 5-year cumulative survival rate of level B group was 71. 28%,which was significantly higher than that of level C group(55. 64%) (χ^

关 键 词：乙型病毒性肝炎肝硬化 抗病毒治疗 CHILD-PUGH分级 生存率 

分 类 号：R512.6[医药卫生—内科学]