应用Cox比例风险模型分析抗病毒治疗对慢性乙型重型肝炎预后的影响

目的应用Cox比例风险模型分析核苷（酸）类似物抗病毒治疗对慢性乙型重型肝炎预后的影响。方法选择219例慢性乙型重型肝炎患者，采用Cox比例风险模型对可能影响其预后的因素进行单变量和多变量回归分析。重点分析核苷（酸）类似物抗病毒治疗对慢性乙型重型肝炎预后的影响。结果多变量回归分析结果显示：年龄、肝性脑病、总胆红素、白蛋白、凝血酶原活动度、血尿素氮、核苷（酸）类似物抗病毒治疗具有独立的预后意义（P〈0．05）。纠正混杂因素后，在多变量Cox比例风险模型中比较拉米夫定与恩替卡韦两种药物对慢性乙型重型肝炎预后的影响程度，两者无显著性差异（P〉0．05）；比较在慢性乙型重型肝炎的早期、中期和晚期抗病毒治疗对预后的影响程度，结果在早期和中期抗与不抗病毒治疗有显著性差异（P〈0．05），但晚期抗与不抗病毒治疗已无显著性差异（P〉0．05）。结论核苷（酸）类似物抗病毒治疗是影响慢性乙型重型肝炎预后的独立因素。较早开始抗病毒治疗可以改善预后。拉米夫定和恩替卡韦均可选用于对这种患者的治疗。

Influence of nucleoside treatment on prognosis of patients with chronic severe hepatitis B

Objective To evaluate the influence of nucleoside treatment on prognosis of patients with chronic severe hepatitis B. Methods 219 patients with chronic severe hepatitis B were included. The factors affecting the prognosis were analyzed by Cox proportional hazard model. Results Muhivariable regression analysis showed that age,hepatic encephalopathy,total serum bilirubin,albumin,prothrombin time activity,blood urea nitrogen and nucleoside treatment were independent factors affecting the prognosis（P〈0.05）. There was no statistically significant difference between entecavir and lamivudine therapy （P〉0.05）;there was an significant difference as respect to with and without antiviral treatment carried out in the early and middle stage of chronic severe hepatitis B （P〈0.05）. Conclusion Nucleoside treatment is the independent factor influencing the prognosis of patients with chronic severe hepatitis B.