长期抗病毒治疗对乙型肝炎肝硬化失代偿期患者生存率的影响

目的 研究长期抗病毒治疗对Child-Pugh B级和C级乙型肝炎肝硬化失代偿期患者生存率的影响.方法 分析2005年1月1日至2010年1月1日就诊的386例乙型肝炎肝硬化失代偿期患者的临床资料,根据Child-Pugh分级对患者进行分组,观察长期抗病毒对不同分级患者生存率的影响.结果 所有HBV相关肝硬化失代偿期患者的5年累计生存率为63.73％(246例).5年累计生存率Child-Pugh B级组患者为73.05％,C级组为56.62％,两组比较差异有统计学意义(x2=12.723,P＜0.01).Child-Pugh B级组第1、2、3年的生存率分别为95.81％、91.88％、95.92％,高于C级组(87.21％ 、83.77％、90.00％),组间差异均有统计学意义(x2=8.595、5.330、3.887,P＜0.05);Child-Pugh B级和C级组患者第4、5年生存率分别为93.62％、92.42％和95.14％ 、90.51％,两组之间比较差异均无统计学意义(x2=0.309、0.289,P＞0.05).经抗病毒治疗5年生存的Child-Pugh B级、C级组患者的肝功能指标、凝血酶原活动度、Child-Pugh评分比较差异均无统计学意义(P均＞0.05).结论无论Child-Pugh B级或C级HBV相关肝硬化失代偿期患者,长期抗病毒治疗的生存率均能超过55.00％,B级患者优于C级患者.Child-Pugh分级较差的生存者经长期抗病毒治疗可获得与分级较轻患者相似的疗效.

Effects of long-term antiviral therapy on survival rate of patients with hepatitis B virus-related decompensated liver cirrhosis

Objective To explore the survival outcomes of patients with Child-Pugh class B and C HBV-related decompensated liver cirrhosis after long-term antiviral therapy.Methods A total of 386 patients with HBV-related decompensated liver cirrhosis in Bethune International Peace Hospital from January 1st 2005 to January 1st 2010 were enrolled.They were divided into different groups according to Child-Pugh score.The long-term survival status of patients was observed after antiviral therapy.Results Five-year survival rate in all HBV-related cirrhosis patients was 63.73％ (246 cases).Five-year survival rates in Child-Pugh class B group and Child-Pugh class C group were 73.05％ and 56.62％ with siginificant difference (x2=12.723,P＜0.01).The survival rates in the first,second and third year were 95.81％,91.88％ and 95.92％,respectively in Child-Pugh B group,which were significantly higher than those in Child-Pugh C group of 87.21％,83.77％ and 90.00％,respectively (x2=8.595,5.330 and 3.887,P all＜0.05).The survival rates in the fourth and fifth year were 93.62％ and 92.42％ in Child-Pugh B group,which had no statistical differences with those in Child-Pugh C group of 95.14％ and 90.51％(x2=0.309 and 0.289,P both＞0.05).The differences on liver function index,prothrombin time activity and Child-Pugh score between Child-Pugh class B and C patients after 5-year antiviral therapy had no statistical significance (P all＞0.05).Conclusions The survival rates of patients with Child-Pugh class B and C HBV-related decompensated cirrhosis exceed 55.00％ after long-term antiviral therapy.Patients with class B have better suvival outcomes than those with class C.Patients with severe Child-Pugh class can achieve similar effect as the mild ones after long-term antiviral therapy.