慢性重型乙型肝炎转归相关因素及抗病毒治疗研究

目的探讨慢性重型乙型肝炎转归的影响因素及抗病毒治疗对其转归的影响。方法应用回顾性研究方法,分析330例慢性重型乙型肝炎患者的年龄、凝血酶原活动度(PTA)、血清中HBeAg、抗-HBe滴度,HBV-DNA定量,有无并发症,抗病毒治疗等因素与转归的关系。结果慢性乙型重型肝炎患者随年龄增加、PTA降低、并发症增多,其死亡率明显增高;慢性乙型重型肝炎患者血清HBV-DNA定量大于1×105拷贝/ml者其死亡率(52.3%)比HBV-DNA小于1×105拷贝/ml的死亡率(32.9%)明显升高;HBeAg,抗-HBe的表达对死亡率无影响;2005年应用拉米夫定抗病毒治疗后慢性乙型重型肝炎HBV-DNA定量大于1×105拷贝/ml的患者其死亡率(30.38%)比2001年未使用抗病毒治疗者(54.64%)明显下降。结论影响慢性乙型重型肝炎预后的因素除年龄、PTA、有较多并发症外,患者血清中高病毒载量是影响其死亡率的关键因素,及时抗病毒治疗可以降低患者的死亡率。

Factors related to the outcome of patients with chronic severe hepatitis B and effectiveness of antivirus therapy

OBJECTIVE: To investigate the factors related to the outcome of patients with chronic severe hepatitis B and effectiveness of antivirus therapy. METHODS: The effects of the factors including age, prothrombin activity (PTA), serum HBeAg, Anti-HBe, HBV-DNA load, with or without complication, antivirus therapy and so on, on outcome of 330 patients with chronic severe hepatitis B were analyzed in this retrospective study. RESULTS: The mortality of patients with chronic severe hepatitis B was significantly higher among patients at higher age, with lower PTA, and with more complications. The mortality of patients with HBV-DNA more than 1x10(5) copies/ml (52.3 percent) was higher than that of patients whose HBV-DNA was less than 1x10(5) copies/ml (32.9 percent). There was no correlation between serum HBeAg or anti-HBe and the mortality. The mortality of patients with HBV-DNA higher than 1x10(5) copies/ml (30.38 percent) who were treated with lamivudine in 2005 was lower than that of patients whose HBV-DNA was less than 1x10(5) copies/ml (54.64 percent) who were not treated with any antiviral therapy in 2001. CONCLUSION: The higher serum virus load is the key factors of the mortality in addition to the other factors such as older age, lower PTA, more complication in the patients with chronic severe hepatitis B. The usage of antivirus therapy may be associated with lower mortality.