恩替卡韦治疗慢加急性乙型肝炎肝衰竭近期疗效评价

目的探讨恩替卡韦治疗慢加急性乙型肝炎肝衰竭近期疗效。方法 68例慢加急性乙型肝炎肝衰竭患者被分成治疗组(42例)和对照组(26例),对照组采用常规内科治疗,治疗组在常规内科治疗基础上加用恩替卡韦0.5mg/d,比较两组治疗后血生化指标、凝血酶原活动度、HBV DNA水平、MELD分值变化及病死率。结果在治疗后12周,治疗组总胆红素和HBV DNA分别为89.7±42.5μmol/L和3.16±2.04log10copies/mL,显著低于对照组患者(145.6±64.2μmol/L和6.28±3.95log10copies/mL,P<0.01),凝血酶原活动度和白蛋白分别为48.5±15.6%和34.8±4.8g/L,显著高于对照组(40.5±12.4%和30.2±4.1g/L,P<0.05或P<0.01);治疗组早中期患者MELD分值和病死率分别为17.6±3.5和20.0%,显著低于对照组(22.4±4.1和52.9%,P<0.05或P<0.01),两组晚期患者MELD分值和病死率差异无统计学意义(P>0.05);治疗组有1例HBeAg阴转,1例HBeAg血清学转换,对照组HBVM无变化。结论恩替卡韦能有效抑制HBV复制,改善慢加急性乙型肝炎肝衰竭患者肝功能,降低早中期患者MELD分值和病死率。尽早抗病毒治疗可提高慢加急性乙型肝炎肝衰竭患者的生存率。

Short-term survival of entecavir administration in patients with acute-on-chronic hepatitis B liver failure

Objective To evaluate the efficacy of entecavir treatment in patients with acute-on-chronic hepatitis B liver failure. Methods 68 patients with acute-on-chronic hepatitis B liver failure were divided into treatment group （n=42）and control group （n=26）. Patients in control group was given the conventional therapy, while those in treatment group was treated with entecavir at dose of 0.5mg daily on the bases of routine treat- ment. After 12 week treatment,the changes of blood biochemical index,prothrombin activity,HBV DNA,MELD scores and mortality rates in the two groups were evaluated. Results At 12 weeks of treatment, the total serum bilirubin and HBV DNA levels in the treatment group were 89.7±42.5μmol/L and 3.16±2.04 log10copies/mL,significantly lower than those in the control group （145.6±64.2μmol/L and 6.28±3.95 log10copies/mL,P〈0.01）;Prothrombin time activity and albumin in the treatment group were 48.5_±15.6% and 34.8±4.8g/L,significantly higher than those in control group （40.5±12.4% and 30.2±4.1g/L,P〈0.05 or P〈0.01）;MELD scores and mortality rates in early and middle stage patients in treatment group were 17.6±3.5 and 20%,significantly lower than those in the control group （22.4±4.1 and 52.9%,P〈0.05 or P〈0.01）;There were no significant differences in MELD scores and mortality rates in late stage patients in the two groups （P〉0.05）. Conclusion Entecavir can effectively suppress HBV replication,improve liver function in patients with acute-on-chronic hepatitis B liver failure. Early antiviral therapy can improve survival rate of patients with acute-on-chronic hepatitis B liver failure.