慢性重型乙肝患者血乳酸水平变化及核苷类抗病毒治疗的疗效分析

目的 探讨慢性重型乙肝患者血乳酸水平变化及核苷类抗病毒治疗的疗效.方法 回顾性分析30例慢性重症肝炎患者的临床资料,检测血乳酸并计算MELD评分.将患者按照入院顺序分两组,分别采用拉米夫定（LAM）、恩替卡韦（ETV）治疗,观察血乳酸和MELD评分的变化.结果 慢性重症肝炎患者随着MELD评分的增加,血乳酸浓度逐渐增加（P＜0.05）;治疗后,两组血乳酸值稍高于治疗前,但组间治疗后比较无统计学意义（P〉0.05）,同时在MELD评分上也无明显改善（P〉0.05）;个例初步分析以乳酸水平轻度升高为多,但无乳酸中毒.结论 MELD评分与血乳酸具有良好相关性,二者联合应用对于病情判断具有重要意义;应用核苷类抗病毒药物的严重肝病患者以血乳酸轻度升高为主,临床上应权衡利弊选择使用并注意监测.

Change of blood lactic acid and effect of antiviral agent of nucleoside in patients with chronic severe hepatitis B

Objective To investigate blood lactic acid change and antiviral agent effect of nucleoside agent on patients with chronic severe hepatitis B. Methods 30 cases of chronic hepatitis B were retrospectively analyzed,and the blood lactic acid and MELD scores were detected and calculated. M1 the patients were divided into two groups according to admission order by treating with LAM and ETV respectively,and the change of blood lactic acid and MELD scores were observed. Results With the increase of blood lactic acid in patients with chronic hepatitis B of severe grade,the MELD scores were also increased （P 〈0.05）. After treatment,blood lactic acid in both groups was slightly higher than that before treatment （P 〉 0.05 ）, while there was no significant difference on blood lactic acid and MELD scores between the two groups after treatment （P 〉 0.05）. Case analysis showed that blood lactic acid was still largely moderately increasing,yet without any case of lactic acid poisoning. Conclusions Obvious correlation exists between MELD score and blood lactic acid. Combined application is of great signfficance for illness judgment. Applicztion of nucleoside antivirul drugs can lead to moderate increase of blood lactic acid,therefore,clinicul use should be based on benefit-risk bulance and focus on surveillance.