抗病毒治疗对HBV DNA阳性乙型肝炎肝硬化门脉高压症患者术后临床转归的影响*

目的 探讨抗病毒治疗对血清HBV DNA阳性的门脉高压症患者术后临床转归的影响。方法 将89例HBV DNA阳性乙型肝炎肝硬化伴门静脉高压症患者随机分成治疗组48例，采用选择性断流联合恩替卡韦治疗和对照组41例，采用单纯手术治疗。常规检测肝功能、HBV DNA定量、Child-Pugh评分和肝纤维化指标。结果 在术后1 m和3 m时，治疗组患者血清HBV DNA水平分别为（5.79±1.78） lgcopies/L和（4.24±1.61） lgcopies/L，显著低于对照组[分别为（7.90±1.83） lgcopies/L和（6.46±1.43）lgcopies/L，P<0.05]；治疗组患者血清ALT和总胆红素较对照组降低，白蛋白升高；治疗组1 a生存率为93.75%，3 a生存率为75%，对照组患者1 a生存率为87.92%，3 a生存率为68.30%，治疗组显著高于对照组（P＜0.05）。结论 抗病毒治疗可以促进HBV DNA阳性的门脉高压症患者术后肝功能恢复，改善患者预后。

Influence of antiviral therapy on the clinical postoperative prognosis of patients with serum HBV DNA-positive hepatitis B related liver cirrhosis and portal hypertension

Objective To explore the effect of antiviral therapy on the clinical postoperative prognosis of patients with serum HBV DNA-positive hepatitis B related cirrhosis and portal hypertension（PH）. Methods 89 patients with serum HBV DNA positive liver cirrhosis and PH were randomly divided into intervention group（n=49） receiving selected splenectomy and entecavir，and control group（n=41） receiving selected splenectomy alone. The liver function tests，serum HBV DNA levels，Child-Pugh scores，liver fibrosis markers were routinely obtained， and the survival rates were observed. Results At the end of 1 month and 3 month after surgery，the serum HBV DNA levels in intervention group were （5.79±1.78） lgcopies/L and （4.24±1.61） lgcopies/L，respectively，while it didn’t change in the control group （P<0.01）；The serum alanine aminotransferase and total bilirubin levels in intervention group decreased，albumin increased as compared to those in control（P<0.01）；the survival rates at 1 a and 3 a in invention group were 93.7% and 75.0%，much higher than 87.9% and 68.3%，in the control （P＜0.05）. Conclusions Antiviral therapy after selected splenectomy in PH patients with positive HBV DNA can promote the 1iver function recovery and better clinical prognosis.