抗病毒治疗对乙型肝炎病毒相关慢加急性肝衰竭患者预后的影响

目的 探讨影响乙型肝炎相关慢加急性肝衰竭( HBV - ACLF)患者90 d预后的因素及抗病毒治疗对HBV-ACLF患者90 d预后的影响.方法 回顾性分析2009年1月-2011年6月在我院住院治疗的HBV-ACLF患者112例,根据入组时是否采用抗病毒治疗分为非抗病毒治疗组54例和抗病毒治疗组58例.非抗病毒治疗组采用内科综合治疗,抗病毒治疗组在内科综合治疗基础上加用抗病毒药物治疗,比较两组患者临床特征、存活率、抗病毒治疗短期疗效及分析影响预后的因素.结果 治疗4周后,两组ALT均显著降低,胆碱酯酶(CHE)和HBV DNA转阴率提高(P＜0.05)；治疗8周后,抗病毒治疗组TBil和MELD评分明显低于非抗病毒治疗组,而凝血酶原活动度(PTA)水平明显高于非抗病毒治疗组(P＜0.05).治疗90 d,抗病毒治疗组累积存活率明显高于非抗病毒治疗组(P=0.025).影响预后的独立危险因素为:HBeAg、肝性脑病、肝肾综合征、抗病毒治疗(P＜0.05).结论 抗病毒治疗可提高HBV-ACLF患者的90 d存活率,是HBV-ACLF内科治疗的有效方法之一；HBeAg阴性、肝性脑病、肝肾综合征也可降低HBV - ACLF患者的90 d存活率.

The influence and prognostic value of antiviral therapy on 90-day outcome of hepatitis B virus-related acute-on chronic liver failure patients

Objective To investigate the influence and prognostic value of antiviral therapy on the 90-day outcome of hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF) patients.Methods One-hundred-and-twelve patients with HBV-ACLF treated in our hospital from January 2009 to June 2011 were enrolled for study.The patients were assigned to the antiviral therapy group(standard therapy plus nucleoside analogue,n =58) or the control group(standard therapy,n =54).The clinical features,survival rate,and short-term efficacy of antiviral therapy were comparatively analyzed between the two groups using the Chi-square test.The relation of prognostic factors was determined by logistic regression analysis.Results After four weeks of treatment,alanine aminotransferase was decreased and cholinesterase was improved significantly in each group(P < 0.05).After eight weeks of treatment,total bilirubin and MELD score were lower and prothrombin activity was higher in the antiviral therapy group than in the control group(P < 0.05).After four weeks of treatment,the HBV DNA-negative rate was higher in the antiviral therapy group(P < 0.05).After 90 days of treatment,the survival rate was significantly higher in the antiviral treatment group(P = 0.025).Hepatitis B virus e antigen(HBeAg),hepatic encephalopathy(HE),hepatorenal syndrome(HRS),and antiviral therapy were identified as prognostic factors of HBV-ACLF.Conclusion Antiviral therapy has a strong beneficial effect on the prognosis of HBV-ACLF patients by improving the 90-day survival rate.HBeAg-negative status and presence of HE or HRS are associated with lower 90-day survival rate.