抗病毒治疗对慢性乙型肝炎肝衰竭1年的疗效

目的探讨抗病毒治疗对慢性乙型肝炎肝衰竭的1年疗效。方法收集慢性乙型肝炎肝衰竭病例，选取54例为抗病毒治疗组，选取历史病例67例为对照组。抗病毒治疗组在常规内科治疗的基础上加用抗病毒药物治疗（拉米夫定、恩替卡韦、替比夫定），对照组仅使用内科常规治疗。分析两组患者在不同时间点病死率、HBVDNA水平、INR、MELD评分及肝功能结果。结果治疗1个月后，两组死亡率差异无统计学意义（P〉0．05）。治疗3个月后，抗病毒治疗组死亡15例（27．8％），显著低于对照组（32例，47．8％），差异有统计学意义（P〈0．05）。治疗1年后抗病毒治疗组死亡15例（27．8％），显著低于对照组（37例，61．7％），差异有统计学意义（P〈0．05）。治疗1个月后，两组患者ALT、AST、TBIL、INR水平及MELD评分差异无统计学意义（P〉0．05）；抗病毒治疗组HBVDNA水平显著低于对照组．差异有统计学意义（P〈0．05）。治疗3个月及1年后抗病毒治疗组AⅡ、AST、TBIL、INR、HBVDNA水平及MELD评分显著低于对照组，差异有统计学意义（P〈0．05）。结论抗病毒治疗可降低慢性乙型肝炎肝衰竭患者的死亡率，加快肝功能好转，抑制病毒复制，具有肯定的治疗作用。病情好转后维持抗病毒治疗，可以明显改善慢性乙型肝炎肝衰竭患者的长期预后。

One year efficacy of antiviral therapy with nucleoside analogues on chronic severe hepatitis B

Objective To investigate the one year efficacy of antiviral treatment in patients with chronic severe hepatitis B. Methods Patients with chronic severe hepatitis B were collected. Antiviral treatment group （54 cases） was treated with antiviral therapy （LAM or ETV or Ltd） and routine supportive therapy, and the control group （67 historical cases） was treated with supportive therapy only. The mortality, hepatitis B virus DNA（HBV DNA） level, INR（international normalized ratio）, MELD score and liver function between the two groups in different time points were compared. Results After 1 month treatment, There was no significant difference in the mortality between the 2 groups（P〉0.05）. But After 3 months treatment, 15 patients died（27.8%）in antiviral treatment group, which was significantly lower than that in the control group 32 patients died （47.8%）, P〈0.05 ]. After 1 year treatment, 15 patients died （27.8%） in antiviral treatment group, which was significantly lower than that in control group 37 patients died （61.7%）, P〈0.05]. After 1 month treatment, There was no significantly difference in the ALT, AST, TBIL, INR and MELD score between the 2 groups （P〉0.05）, but the level of HBV DNA in antiviral treatment group was significantly lower than that of control group （P〈0.05）. After 3 months and one year treatment, the ALT, AST, TBIL, INR and MELD score and the level of HBV DNA in antiviral treatment group were all significantly lower than those in control group （P〈0.05）. Conclusion Antiviral treatment can decrease mortality, improve liver function, inhibit viral replication, with a positive therapeutic effect.Antiviral treatment should be maintained after patients are better, for it can improve long term prognosis.