摘要
目的研究在乙型肝炎相关慢加急性肝衰竭抗病毒治疗过程中早期快速病毒学应答对治疗转归的影响。方法回顾性分析我院2008年1月-2010年7月的乙型肝炎相关陧力Ⅱ急性肝衰竭患者106例，在内科综合治疗基础上，分别给予拉米夫定（100mg／d）或恩替卡韦（0．5mg／d）抗病毒治疗，在治疗基线和第4周检测患者生物化学、凝血功能和HBVDNA载量，根据第4周的HBVDNA载量分为HBVDNA阳性组和阴性组，比较两组间临床特征和治疗转归的差别。用，检验或Fisher精确概率法比较率，用独立样本t检验比较均数，对影响治疗转归的所有因素进行多元logistic逐步回归分析。结果治疗第4周时，HBVDNA阳性和阴性组TBil分别为（261．6±205．6）umol／L、（160．1±173．4）umol／L，两组比较，t=2．190，P〈0．05，差异有统计学意义。两组PTA分别为44．％±19．7u／0、56．8％±23．1％，两组比较，t=-2．077，P〈0．05，差异有统计学意义。HBVDNA阳性组和阴性组在治疗终点时的治疗无效率分别为50%（9／18）、14．8%（13／88），两组比较，X^2=9．235，P〈0．01，差异有统计学意义。病情分期（早、中、晚期）影响治疗转归的OR值为6．559，95％可信区间为2．316～18．576；HBVDNA阴转影响治疗转归的OR值为0．209，95％可信区间为0．058～0．747。结论核苷类似物对病毒的快速抑制可提高乙型肝炎相关慢加急性肝衰竭的疗效，治疗4周内的早期病毒学应答有助于判断疾病预后。
Objective To investigate the impact of early rapid virological response on the outcomes of hepatitis B associated acute on chronic liver failure during antiviral treatment. Methods 106 acute on chronic liver failure patients in our hospital from January 2008 to July 2010 were enrolled in present study retrospectively. Besides internal medicine therapy, all patients received lamivudine （100 mg/d） or entecavir （0.5 mg/d） treatment. The profile of liver biochemistry, prothrombin time activity and viral load were detected at baseline and week 4, respectively. The patients were divided into HBV DNA negative group and HBV DNA positive group according to the viral load at week 4. The clinical features and treatment outcomes were compared between groups. Frequency variables were compared by x2 test or Fisher＇s exact test. Continuous variables were compared using independent samples T-test. The factors that impact on the treatment outcomes were determined using stepwise multivariate logistic regression analysis. Results At the week 4, the TBil and PTA in HBV DNA positive group {（261.6±205.6）μmol/L and 44.7% ± 19.7%, respectively}were significantly different from those in HBV DNA negative group {（160.1± 173.4） μ mol/L and 56.8%± 23.1%, respectively} （t = 2.190 and -2.077, respectively, P 〈 0.05）. The non-effective rate of HBVDNA positive group （50%, 9/18） was significantly higher than that of HBV DNA negative group （14.8%, 13/88） （ x2 = 9.235, P〈 0.01）. By using stepwise multivariate logistic regression analysis, the disease stage and HBV DNA undetectable at week 4 were the independent factor. The OR values of disease stage and HBV DNA undetectable were 6.559 and 0.209, respectively, and 95% CI was 2.316-18.576and 0.058-0.747, respectively. Conclusion The rapid suppression of viral load by nucleotide analogue may improve the efficacy of hepatitis B associated acute on chronic liver failure treatment. The early rapid virological response within first 4 weeks may contribute to the prediction of the treatment outcomes.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2011年第10期734-737,共4页
Chinese Journal of Hepatology
基金
艾滋病和病毒性肝炎等重大传染病防治科技重大专项（20082X10002-005）
国家自然科学基金（81000759）
福州市科技计划项目（2009-G-102）
