拉米夫定联合胸腺肽α1治疗慢性乙型重型肝炎对预后的影响

目的应用终末期肝病模型（MELD）评分系统预测拉米夫定联合胸腺肽α1治疗慢性乙型重型肝炎患者的预后。方法96例慢性乙型重型肝炎患者被随机分为治疗组与对照组，应用MELD评分系统比较两组患者病死率和治疗前后的血生化指标变化。结果在MELD≤30的患者，治疗后血清总胆红素（TBIL）、凝血酶原时间国际标准化比值（INR）、血清肌酐（Cr）、MELD评分明显低于治疗前。差异有统计学意义（P〈0．01），治疗组患者的病死率为47．4％，低于对照组的78．9％，差异有统计学意义（P〈0．05）；在MELD分值30～39的患者，治疗后的TBIL、INR、Cr、MELD评分低于治疗前，治疗组患者的病死率为72．0％，与对照组的86．9％相比，差异无统计学意义（P〉0．05）；在MELD分值≥40的患者，治疗后的TBIL、INR、Cr、MELD评分与治疗前差异无统计学意义（P〉0．05），两组的病死率均为100％。结论拉米夫定联合胸腺肽α1治疗可降低MELD≤30的慢性乙型重型肝炎患者的病死率，但不能降低MELD〉30患者的病死率，故治疗宜在疾病的早期使用。

The short-term prognosis of patients with chronic severe hepatitis B by the treatment of lamivudine and thymosin-α1

Objective To study the prognosis of patients with chronic severe hepatitis B by the treatment of lamivudine and thymosin-α1 using the model for end-stage liver disease （MELD） scoring system. Methods 96 patients were randomly divided into treatment group and control group. The efficacy of the treatment with lamivudine and thymosin-α1 was assessed by mortality and improvement in biochemical parameters. Results The mortality of patients receiving lamivudine and thymosin-α1 treatment with MELD score less than 30 was 47.4 %, while it was 78.9 % in patients without lamivudine and thymosin-α1 treatment（P〈0.05）. In patients with MELD scores between 30 and 39, the mortality were 72.0% and 86.9 %, respectively with and without lamivudine and thymosin-α1 treatment （P〉0.05）. All patients with MELD scores greater than 40 died, no matter with or without lamivudine and thymosin-α1 treatment. Conclusion The treatment with lamivudine and thymosin-α1 can decrease the mortality of patients with MELD score less than 30.