HBV DNA阳性慢性重型乙型肝炎的抗病毒疗效分析

目的：探讨核苷类抗病毒药治疗对HBV DNA阳性慢性重型乙型肝炎患者短期生存率的影响及不同药物的疗效差异。方法：将入院时432例HBV DNA阳性的慢性重型乙型肝炎患者分为两组：230例为抗病毒组（根据服用不同抗病毒药又分为3组）,202例为对照组。比较两组患者治疗12周的生存率及总胆红素（TBil）、凝血酶原活动度（PTA）、HBV DNA转阴率的差异,同时比较不同抗病毒药物治疗12周的生存率差异和生化指标及HBV DNA阴转的差异。结果：①治疗12周生存率抗病毒组为70.70%,对照组为58.50%,两组比较差异有显著性意义（P〈0.05）。②治疗12周HBV DNA阴转率,抗病毒组为69.06%（96/139）,对照组为32.29%（31/96）,两组比较差异有显著性意义（P〈0.01）。③不同抗病毒药物中12周生存率,恩替卡韦组为73.30%,拉米夫定组70.50%,替比夫定组67.70%,3种药物比较差异无显著性意义（P〉0.05）。④治疗12周时患者TBil、PTA、HBV DNA转阴率拉米夫定组分别为（83.63±99.47）μmol/L、（58.57±16.69）%、65.08%,替比夫定组分别为（102.33±113.58）μmol/L、（55.61±15.98）%、69.23%,恩替卡韦组分别为（70.66±108.86）μmol/L、（57.46±17.12）%、74.00%。3组比较差异均无显著性意义（P〉0.05）。结论：抗病毒治疗可以改善慢性重型乙型肝炎的预后及肝功能,常用的3种核苷类药物疗效的差异无统计学意义。

Clinical analysis of antiviral treatment in chronic severe hepatitis B with HBV DNA positive

Objective：To explore the influence of nucleoside antiviral treatment on short-term survival rate in severe chronic hepatitis B patients with HBV DNA positive and effect differences of different medicines.Methods：The patients of severe 424 chronic hepatitis B with HBV DNA positive were divided into two group∶225 patients were anti-virus group and 199 patients were control group at admission.The differences of survival rates as well as the level of total bilirubin（TBil）,prothrombin activity（PTA）,HBV DNA negative conversion rate of the two groups at 12 week was compared.The 12-week survival rates of different antiviral medicine groups were compared too.Results： ① The 12-week survival rate of antiviral treatment group was 70.70% and the rate of control group was 58.5%.There was significant difference between the two groups（P0.05）.②The HBV DNA negative conversion rate were 69.09%（96/139）in antiviral group at 12 weeks therapy and 32.29%（31/96）in control group.There was significant difference in two groups（P0.05）.③For different antiviral medicine groups,the 12-week survival rate was 73.30% in entecavir group,70.50% in lamivudine group and 67.70% in telbivudine group.Three kinds of medicines showed no significant difference（P0.05）.④The level of TBil,PTA,HBV DNA negative conversion rate were respectively（83.63±99.47）μmol/L,（58.57±16.69）%,65.08% in lamivudine group at 12 weeks and were respectively（102.33±113.58）μmol/L,（55.61±15.98）%,69.23% in telbivudine group and were respectively（70.66±108.86）μmol/L,（57.46±17.12）%,74.00% in entecavir group.There was no significant difference between these indicators in three groups（P0.05）.Conclusion：Antiviral treatment can improve the prognosis in severe chronic hepatitis B patients.Three kinds commonly used nucleoside medicines have no significant difference in efficacy.