用核苷(酸)类似物治疗乙肝患者致病情加重42例临床分析

目的:分析核苷(酸)类似物治疗乙肝患者后病情加重的可能原因。方法:对42例用核苷(酸)类似物抗病毒治疗后病情加重的乙肝患者的资料进行回顾性分析。结果:予乙肝患者抗病毒治疗2周时谷丙转氨酶(ALT)、总胆红素(TBIL)在治疗2,4,6周较治疗前明显上升,差异具统计学意义(P<0.05);反之,凝血酶原活动度(PTA)在治疗2,4周,前白蛋白(PAB)在治疗2,4周时较治疗前均明显下降,差异具统计学意义(P<0.05),而白蛋白(ALB)值变化不大;HBV-DNA定量,治疗后4周即明显下降,差异具统计学意义(t=12.55,P<0.01),其中13例低于检测值,治疗8周时34例低于检测值,12周时HBV-DNA定量均低于检测值。结论:42例患者抗病毒治疗后,HBV-DNA定量下降明显,肝功能指标未改善,尚有恶化趋势,主要表现在予抗病毒治疗后2～4周间,包括黄疸加深,ALT升高,PAB和PTA下降,伴有乏力及消化道等不良反应症状,部分患者出现顽固性腹水,甚至死亡;应用核苷(酸)类似物治疗乙肝患者时应重视其早期病情的变化,以避免肝脏失代偿的发生。

Clinical Analysis of Nucleos(t)ide Analogues in Treatment of 42 cases with Hepatitis B Patients Sicker

Objective： To analyze the possible reasons of the nucleos（t）ide analogues in treatment of hepatitis B patients stoker. Methods： Forty-two patients with exacerbations of hepatitis B using antiviral therapy with nucleos（t）ide analogues were retrospectively analyzed. Results： In hepatitis B patients with antiviral treatment for two weeks, alanine aminotransferase（ALT）, total bilirubin （TBIL） for 4 and 6 weeks of treatment significantly increased than before treatment and the difference was statistically significant （P〈0.05）; On the contrary, prothrombin activity （PTA） in the treatment of 2 and 4 weeks, prealbumin （PAB） in 2 and 4 weeks of treatment were significantly decreased than before treatment and the difference was statistically significant （P〈0.05）; while the white protein（ALB）changed little. HBV-DNA in four weeks after treatment decreased and the difference statistically significant （t=12.55, P〈0.01）, of which 13 were below the detection value, eight weeks of treatment, 34 cases below the detection value HBV-DNA in 12 weeks to the detected value. Conclusion： Forty-two patients with antiviral therapy, HBV-DNA quantitative significantly decreased and the liver function indicators had no improvement. There are signs of deterioration, mainly in 2 to 4 weeks using antiviral therapy, including jaundice deepened, ALT increased, PAB and PTA declined, accompanied by fatigue, and gastrointestinal symptoms of adverse reactions in some patients with refractory ascites, and even death; Nucleos（t）ide analogues treatment of patients with hepatitis B should attach importance to the changes under the early condition to avoid the occurrence of hepatic decompensation. KEYWORDS