HBeAg阴性乙型肝炎ACLF患者的临床特征及抗病毒治疗短期疗效

目的 观察HBeAg阴性乙型肝炎慢加急性肝衰竭患者的临床特征及应用恩替卡韦抗病毒治疗的短期疗效.方法 132例HBeAg阴性和51例HBeAg阳性乙型肝炎慢加急性肝衰竭患者,分为常规治疗组及抗病毒治疗组,抗病毒组在常规内科治疗基础上加用恩替卡韦0.5 mg/d治疗,比较两组患者临床特征、病死率及抗病毒治疗短期疗效差异.结果 与HBeAg阳性组比较,HBeAg阴性组年龄较大(P=0.001),血清HBV DNA定量较低(P=0.001).HBeXS阴性组与HBeAg阳性组肝衰竭分期构成比及常规治疗病死率比较无差异.应用恩替卡韦抗病毒治疗时HBeAg阴性组生存率为54.24%,高于常规治疗组(35.62%),P=0.032,低于HBeAg阳性抗病毒组(80.00%),P=0.004.HBeAg阴性组血清HBV DNA在(3～5)log10拷贝/ml时,抗病毒治疗组生存率为55.56%,高于常规治疗组(20.00%),P=0.011.结论 乙型肝炎慢加急性肝衰竭患者中,常规治疗下HBeAg阴性患者与HBeAg阳性患者的病死率无差异.采用恩替卡韦抗病毒治疗能提高HBeAg阴性患者的生存率.在HBV DNA低水平复制的HBeAg阴性患者中恩替卡韦抗病毒治疗能提高生存率.

The clinic features and the short-term efficacy of Entecavir treatment of the HBeAg negative acute-on-chronic hepatitis B liver failure

Objective To investigate the clinical features and the short-term efficacy of ETV treatment of the HBeAg negative acute-on-chronic hepatitis B liver failure. Methods 132 HBeAg negative and 51 HBeAg positive patients with acute-on-chronic liver failure were rolled.84 patients were treated with ETV (0.5 nag daily) and routine supportive therapy. 99 patients in the control group received supportive therapy only. The clinical features and the short-term (180 days) efficacy of ETV were compared between the HBeAg negative and HBeAg positive groups. Results The age of HBeAg negative patients was significantly higher ( P=0.001 ). The viral load was significantly higher in the HBeAg positive group ( P=0.001 ). There was no significant difference in the severity and the mortality in control group between the different HBeAg groups. In the antiviral treatment groupa,20/ 25 HBeAg positive patients survived and 32/59 HBeAg negative patients survived (P = 0.004) .The mortality of HBeAg negative patients in control group was higher than that in treatment group ( P = 0.032). In HBeAg negative patients with the HBV DNA < 5 log copies/ml and HBV DNA 3 log copies/ml,10/18 patients in treatment group survived and 6/30 patients in control group survived ( P = 0.011 ). Conclusions There was no significant difference in the mortality between different HBeAg patients in routine treatment group. Antiviral therapy with ETV significantly improve survival rate in HBeAg negative patients. In patients with the HBeAg negative and HBV DNA < 5 log copies/ml and 3 log copies/ml,antiviral therapy with ETV can improve the survival rate.