恩替卡韦抗病毒治疗的乙型肝炎失代偿期肝硬化患者并发症的再代偿  

Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy

作　　者：张婷[1] 邓优 康海燕[2] 向慧玲[3] 南月敏[4] 胡瑾华 孟庆华[6] 房继莲[7] 胥婕[8] 王晓明[9] 赵红[1] Calvin Q.Pan 贾继东[9] 徐小元[10] 谢雯[1] Zhang Ting;Deng You;Kang Haiyan;Xiang Huiling;Nan Yuemin;Hu Jinhua;Meng Qinghua;Fang Jilian;Xu Jie;Wang Xiaoming;Zhao Hong;Calvin Q.Pan;Jia Jidong;Xu Xiaoyuan;Xie Wen(Center of Liver Diseases,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;The Sixth Department of Infectious Diseases,Shijiazhuang Fifth Hospital,Shijiazhuang 050021,China;Department of Hepatology and Gastroenterology,the Third Central Hospital of Tianjin,Tianjin 300170,China;Department of Traditional and Western Medical Hepatology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Liver Disease,the Fifth Medical Centre of Chinese PLA General Hospital,Beijing 100071,China;Department of Liver Disease,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Beijing Key Laboratory of Liver Diseases,Peking University People's Hospital,Beijing 100044,China;Department of Infectious Diseases,Peking University Third Hospital,Bejing 100191,China;Liver Research Center,Beijing Friendship Hospital,Capital Medical University,Bejing 100050,China;Department of Gastroenterology,Peking University First Hospital.Beijing 100034,China)

机构地区：[1]首都医科大学附属北京地坛医院肝病中心,北京100015 [2]石家庄市第五医院感染六科,石家庄050021 [3]天津市第三中心医院消化肝病科,天津300170 [4]河北医科大学第三医院中西医结合肝病科,石家庄050051 [5]中国人民解放军总医院第五医学中心肝病医学部,北京京100071 [6]首都医科大学附属北京佑安医院肝病重症医学科,北京100069 [7]北京大学人民医院北京大学肝病研究所,北京100044 [8]北京大学第三医院感染疾病科,北京100191 [9]首都医科大学附属北京友谊医院肝病中心,北京100050 [10]北京大学第一医院消化科,北京100034

出　　处：《中华肝脏病杂志》2023年第7期692-697,共6页Chinese Journal of Hepatology

基　　金：北京市科学技术委员会资助项目(D171100003117005、Z191100007619037);北京市医院管理中心消化内科学科协同发展中心消化专项重点项目(XXZ04);首都卫生发展科研专项(CFH2022-2-2174)。

摘　　要：目的分析恩替卡韦抗病毒治疗后慢性乙型肝炎失代偿期肝硬化患者再代偿的发生情况。方法前瞻性纳入以腹水为首发表现的慢性乙型肝炎失代偿期肝硬化患者,接受恩替卡韦治疗120周,每24周对患者进行1次随访(包括临床终点事件、血液学及影像学指标等),根据Baveno VII标准计算再代偿率。计量资料组间比较采用Student t检验或Mann-whitney U检验;计数资料的组间比较采用χ^(2)检验或Fisher确切概率法。结果在入组的320例患者中,283例完成了120周的随访,其中92.2%(261/283)的患者实现了病毒学应答。(HBV DNA<20 IU/ml),治疗后患者的Child-Pugh评分和MELD评分明显改善[(8.33±1.90)分与(5.77±1.37)分,t=12.70,P<0.001;(13.37±4.44)分与(10.45±4.58)分,t=5.963,P<0.001]。在120周随访期间,14例患者死亡,2例接受肝移植,19例发展为肝细胞癌,11例发生食管胃底静脉曲张出血,4例发生肝性脑病;60.4%(171/283)的患者在120周内实现了临床再代偿(持续12个月未发生失代偿事件),56.2%(159/283)的患者实现了再代偿(持续12个月未发生失代偿事件且肝功能好转);基线MELD评分>15的患者积极抗病毒治疗后实现再代偿的概率高于基线MELD评分≤15的患者[67.6%(50/74)与52.2%(109/209),χ^(2)=5.275,P=0.029]。结论乙型肝炎失代偿期肝硬化患者抗病毒治疗可以显著改善预后,大部分患者(56.2%)可以实现再代偿,基线病情较重的患者实现再代偿的概率并不低于其他患者。Objective To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy.Methods Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled.Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks(including clinical endpoint events,hematological and imaging indicators,and others)were calculated for recompensation rates according to the Baveno VII criteria.Measurement data were compared using the Student t-test or Mann-Whitney U test between groups.Categorical data were compared by theχ^(2) test or Fisher's exact probability method between groups.Results 283 of the 320 enrolled cases completed the 120-week follow-up,and 92.2%(261/283)achieved a virological response(HBV DNA 20 IU/ml).Child-Pugh and MELD scores were significantly improved after treatment(8.33±1.90 vs.5.77±1.37,t=12.70,P<0.001;13.37±4.44 vs.10.45±4.58,t=5.963,P<0.001).During the 120-week follow-up period,14 cases died,two received liver transplants,19 developed hepatocellular cancer,11 developed gastroesophageal variceal bleeding,and four developed hepatic encephalopathy.60.4%(171/283)(no decompensation events occurred for 12 months)and 56.2%(159/283)(no decompensation events occurred for 12 months and improved liver function)of the patients had achieved clinical recompensation within 120 weeks.Patients with baseline MELD scores>15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores≤15[50/74(67.6%)vs.109/209(52.2%),χ^(2)=5.275,P=0.029].Conclusion Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis.The majority of patients(56.2%)had achieved recompensation.Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

关 键 词：慢性乙型肝炎 失代偿期肝硬化 再代偿 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]