慢性重型乙型肝炎预后影响因素分析及拉米夫定抗病毒治疗对患者生存的影响

目的探讨慢性重型乙型肝炎预后影响因素及应用拉米夫定（LAM）抗病毒治疗对患者生存的影响。方法选择经LAM治疗的810例慢性巫型乙型肝炎患者临床指标和随访资料，用Cox比例风险模型对预后因素进行分析，并比较抗病毒治疗对患者近期临床指标和远期生存的影响。结果除年龄、总胆红素、凝血酶原时间、国际标准化比率（INR）、白细胞和肌酐外，血清HBVDNA和钠水平是影响患者预后的重要因素，其风险比（RR）分别为2．347和0．023。早期和晚期抗病毒治疗组患者中位生存时间分别54d和36d，3个月的中位生存率分别为41．6％和18．3％（X^2=153．230，P〈0．001）。结论血清HBVDNA和钠水平是影响生存的重要因素；尽早抗病毒治疗和纠正低钠血症可能改善慢性重型乙型肝炎患者的生存。

Analysis of prognostic factors in patients with chronic severe hepatitis B and effects of lamivudine antiviral therapy on the patient's survival

Objective To investigate the prognostic factors and effects of lamivudine antiviral therapy on patients with chronic severe hepatitis B. Method The clinical and laboratory variables and follow-up data of 810 patients with chronic severe hepatitis B, who received lamivudine treatment from January, 2000 to December, 2006, were collected, and prognostic factors were analyzed with Cox univariate model. The effects of anti-HBV therapy on clinical indices and long-term survival rate of patients in early and advanced stages were also compared. Results Besides age, total bilirubin, prothrombin time, international normalized ratio, leucocyte and creatinine, the serum HBV DNA level and the serum sodium level were important prognostic factors, with the risk ratio（RR） 2.347 and 0.023, respectively. In early and advanced anti-HBV therapy group, the median survival time was 54 and 36 days, respectively, and the median survival rate for 3 months was 41.6% and 18.3%, respectively （ X^2=-153.230,P〈0.001 ）. Conclusions The serum HBV DNA level and the serum sodium level are important prognostic factors. Timely antiviral therapy and correction of severe hyponatraemia may improve the survival rate of patients with chronic severe hepatitis B.