肝衰竭程度对拉米夫定治疗HBeAg阴性ACLF生存率的影响

【目的】探讨在HBeAg阴性慢加急性肝衰竭（ACLF）患者，拉米夫定治疗开始时肝功能衰竭程度对其转归的影响。【方法】分析71例接受拉米夫定+内科基础治疗患者在治疗开始时、治疗后或临终前的MELD值和血清HBV DNA载量，比较不同MELD值范围者生存率。【结果】MELD高分值组（≥31分）25例，治疗开始和临终前MELD值依次为33.97±3.59和38.89±9.29，HBV DNA载量分别为5.58±1.86和3.56±1.05 log10 copies/mL；MELD中分值组（23～31分）27例，MELD值由治疗前25.45±2.63升至治疗后29.65±9.90，HBV DNA载量由5.53±1.83降为3.23±1.07 log10 copies/mL；MELD低分值组（≤23分）19例，MELD值由治疗前19.54±1.96降至治疗后15.66±7.98，HBV DNA载量由6.34±1.63降为3.11±0.97 log10 copies/mL。各组内比较，治疗前后MELD值、HBV DNA载量的差异均有统计学意义（P <0.05）。三组间比较，治疗前后HBV DNA载量的差异均无统计学意义（P >0.05），但患者生存率依次为8.00%(2/25)，55.56％(15/27）和84.20%(16/19)，组间两两比较的差异均有统计学意义（P <0.05）。【结论】治疗开始的肝衰竭程度显著影响HBeAg阴性ACLF患者拉米夫定+内科基础治疗转归。当MELD值≥31分，生存率低。

Effect of Liver Failure Degree on Survival Rate in Patients with HBeAg-negative ACLF after Lamivudine Treatment

【Objective】 To investigate the effect of pretreatment liver failure degree on the outcome of patients with HBeAg-negative acute-on-chronic liver failure(ACLF) lamivudine treatment.【Methods】 A total of 71 patients received lamivudine plus basic medical treatments.Their serum HBV DNA loads and MELD scores were statistically analyzed at pretreatment,post-treatment or death before.And the survival rates of different MELD scores ranges were compared.【Results】 25 patients had pretreatment MELD scores above 31,whose MELD scores of pretreatment and before death were 34 ± 4 and 39 ± 9.9,respectively.Meanwhile,HBV-DNA loads were 5.6 ± 1.9 and 3.6 ± 1.0 log10 copies/mL in order.For 27 patients with pretreatment MELD scores ranged from 23 to 31,their MELD scores increased from 25 ± 3 to 30 ± 10 while HBV-DNA loads decreased from 5.5 ± 1.8 to 3.2 ± 1.1 log10 copies/mL after treatment.MELD scores decreased from 19.5 ± 2.0 to 15.7 ± 8.0 and HBV-DNA loads decreased from 6.3 ± 1.6 to 3.1 ± 1.0 log10 copies/mL in 19 patients with pretreatment MELD scores below 23.In each group,there were significant differences in MELD scores and HBV DNA loads between pretreatment and post-treatment statistically(P < 0.05).Among three groups,no significant difference was found in HBV DNA loads at pretreatment and post-treatment(P > 0.05).The survival rates were 8.00%(2/25),55.56%(15/27),and 84.20%(16/19) in sequence and there were significant differences(P < 0.05).【Conclusions】 Pretreatment liver failure degree significantly affects the outcome of lamivudine plus basic medical treatment on patients with HBeAg-negative ACLF.For patients with pretreatment MELD score above 31,the survival rate is low.