乙肝病毒耐药导致慢性重型肝炎的抗病毒治疗临床疗效分析

目的：分析乙肝病毒耐药导致慢性重型肝炎的抗病毒治疗临床疗效。方法：选取本院2009年12月-2012年12月收治的73例于院外口服核苷类似物进行抗乙肝病毒治疗后出现慢性重型肝炎的患者为研究对象，按照入院顺序分为对照组38例和观察组35例。对照组给予常规的保肝、减黄、营养支持等对症治疗，观察组在对照组的基础上继续给予核苷类似物恩替卡韦治疗。比较两组治疗后死亡率、HBV-DNA阴转率及两组患者治疗前后谷丙转氨酶（ALT）、血清总胆红素（T-BILI）、白蛋白（ALB）、凝血酶原活动度（PTA）等肝功能指标变化。结果：治疗24周后，观察组死亡率2.86%，明显低于对照组的18.42%（X2=4.523，P=0.036），HBV-DNA阴转率88.57%，明显高于对照组的39.47%（X2=16.408，P=0.000）。两组患者治疗前ALT、ALB、TBIL、PTA比较差异均无统计学意义（P〉0.05）。经过治疗后，对照组患者的ALT、TBIL均明显高于观察组，而ALB、PTA均明显低于观察组，差异均有统计学意义（P〈0.05）。结论：对于乙肝病毒耐药导致慢性重型肝炎的患者，抗病毒药物可以降低患者死亡率、提高患者HBV-DNA阴转率，促进肝脏生化功能提高，值得临床上推广应用。

Clinical Analysis of Antiviral Therapy for Chronic Severe Hepatitis Triggered by Drug-fast Hepatitis B Virus

Objective：To analyze the clinical effect of antiviral therapy for chronic severe hepatitis triggered by drug-fast hepatitis B virus.Method：73 patients who degenerated into chronic severe hepatitis after the treatment of oral nucleoside analogs in our hospital from December 2009 to December 2012 were selected,and they were divided into the control group for 38 cases and the observation group for 35 cases.The control group was given symptomatic treatment such as routine liver protection,anti choleplania and nutritional support,etc,the observation group was given nucleoside analogues entecavir on the basis of the control group.The mortality rate,HBV-DNA negative conversion rate were compared between the two groups;At the same time,the serum liver function indexes of alanine aminotransferase（ALT）,total bilirubin（T-BILI）,albumin（ALB）and prothrombin activity（PTA）were also detected and contrastive analyzed.Result：After 24 weeks’ treatment,the mortality rate of observation group was 2.86%,it was significantly lower than 18.42%of the control group（X2=4.523,P=0.036）,the negative rate of HBV-DNA was 88.57%,it was higher than 39.47%of the control group（X2=16.408,P=0.000）.In addition,there was no significant difference in serum ALT,ALB,TBIL and PTA levels between the two groups before treatment（P〉0.05）;After treatment,the ALT,TBIL in the control group were significantly higher than those in the observation group,while ALB,PTA were significantly lower than those in the observation group （P〈0.05）.Conclusion：For the hepatitis B virus resistance leading to chronic severe hepatitis patients,antiviral drugs can reduce the mortality of patients,improve patient HBV-DNA negative conversion rate,improve the liver function tests, worthy of clinical application.