恩替卡韦治疗乙型慢加亚急性肝衰竭患者疗效分析

目的回顾分析乙型慢加亚急性肝衰竭患者应用恩替卡韦抗病毒治疗96周的疗效。方法收集40例乙型慢加亚急性肝衰竭患者的基线临床资料与0,4、12、24、48、72、96周的临床检测指标的变化。结果恩替卡韦用药4、12、24、48、72、96周时HBVDNA在检测阴性的比率为32．5％、80．O％、90．O％、95．0％、100．O％、100．0％。e抗原阴转率于24、48、72、96周分别为18．7％、31．2％、43．7％、43．75％，e抗原血清学转换率于48、72、96周分别为12．5％、12．5％、18．7％。ALT、AST、TBiL、ALB、PTA（凝血酶原活动度）复常率96周时分别为100．0％、85．0％、27．5％、100．0％、92．5％。96周时从C级变为A级、B级比例（％）：低病毒载量组相对Child—pugh评分改善明显，两者有统计学意义。96周时合并症的有效控制率分别为：上消化道出血88．0％，自发性细菌性腹膜炎（SBP）100．0％，肝性脑病80．0％。应用恩替卡韦安全性良好，无明显不良反应发生。结论恩替卡韦治疗乙肝肝衰竭患者能迅速地抑制HBVDNA复制，而且因为无耐药的发生，改善肝功能的同时，有效地控制了肝硬化合并症，并且药物安全性得到验证，值得推广。

Efficacy of entecavir in treatment of subacute chronic liver failure patients with chronic hepatitis B.

Objectives To evaluate the efficacy of entecavir in treatment of 96 subacute chronic liver failure patients with chronic hepatitis B. Methods The data of gender,age,course of disease,Child-pugh classification of cirrhosis and chemistry parameters of ALT ＆ AST, TbiL,ALB,PTA,HBeAg seroconversion,HBVDNA from 40 patients with HBeAg-positive chronic hepatitis B were collected, and the fluctuations of these clinical chemistry parameters were observed at week 0,4,12,24,48,and 96. Results Virological response： among patients treated in week 4,12,24,48,72,and 96 of entecavir,the HBV DNA under the tested levelwere 32.5,80,90,95.00,100,and 100,respectively. HBeAg seroconversion rate （ % ）were 18.7,31.2,43.7, and 43.7 in week 24,48,72, and 96, and HBeAg seroconversion rate （ % ） were 12.5,12.5, and 18.7 in week 48,72,and 96,respectively. The rate of ALT,AST,TbiL,ALB,and PTA were 100,85,27.5,100,92.5 at weeks 96,respectively. The proportion of patients fi＇om Grade C to Grade A and Grade B through 96 weeks： there was a significant improvement of child-pugh for the HBVDNA 〈l.0xlO5cp/ml group. Through 96 weeks, the effective control rate of combined upper alimentary canal haemorrhage was 88%, the effective control rate of combined spontaneous bacterial peritonitis（SBP） was 100% ,and the effective control rate of combined hepatic encephalopathy was 80%. Through 96 weeks,no patient experienced virological breakthrough due to entecavir resistance. Conclusions Entecavir treatment is effective in treatment of subacute chronic liver failure in patients with chronic hepatitis B as it can immediately control the reproduction of HBVDNA. In addition,because no patient experienced virological breakthrough due to enteeavir resistance,the entecavir therapy can improve the function of liver,and control the combined sclerosis effectively.and safely.