摘要
目的 探索不同MELD评分范围的HBeAg阴性慢加急性肝衰竭患者在内科综合治疗基础上加用恩替卡韦抗HBV治疗的时机和疗效.方法 观察并比较101例三种MELD评分范围HBeAg阴性慢加急性肝衰竭加用恩替卡韦（博路定）抗HBV开始治疗时、恢复期或临终前的MELD评分,HBV DNA载量和死亡率.结果 MELD高评分组（≥30分）20例,用药疗程（14.6±14.1）d,治疗前后MELD评分分别（36.03 ±5.01）分和（39.86±5.95）分,差异有统计学意义（t=-2.994,P =0.007）；治疗前后HBV DNA载量分别为（4.454±1.714）和（3.979±1.947）拷贝log10/ml,差异无统计学意义（t =2.212,P=0.051）,死亡率为100％（20/20）.MELD中评分组（22～30分）47例,用药疗程（51.5±41.6）d,治疗前后MELD评分分别为（25.71 ±2.47）分和（26.18±13.32）分,差异无统计学意义（t=-0.263,P=0.794）；治疗前后HBV DNA载量分别为（6.084±1.795）和（3.378±2.156）拷贝log10/ml,差异有统计学意义（t=7.148,P=0.000）,死亡率53.19％ （25/47）.MELD低评分组（≤22分）34例,用药疗程（67.2±40.9）d,治疗前后MELD评分为（18.85±2.72）分和（11.68±7.23）分,差异有统计学意义（t=5.983,p=0.000）；治疗前后HBV DNA载量分别为（5.945±1.635）和（2.725 ±1.194）拷贝log10/ml,差异有统计学意义（t=9.962,P=0.000）,死亡率2.94％（1/34）.结论 HBeAg阴性慢加急性肝衰竭,在内科综合治疗的基础上加用恩替卡韦进行抗病毒治疗,当MELD评分≤22分时,患者基本可存活；当MEID评分在22～30时,死亡率为53.19％ （25/47）；当MELD评分≥30分时,几乎错过治疗时机,最终出现致死性肝衰竭,应考虑肝移植治疗.
Objective To explore the opportunity and effect of internal general treatment added entecavir on acute-on-chronic liver failure （ACLF） of HBeAg-negative chronic hepatitis B patients in different ranges of MELD score.Methods A total of 101 ACLF of HBeAg-negative chronic hepatitis B patients treated with internal general treatment added entecavir were divided into three groups according to the M ELD score.The mortalities and H BV DNA loads during the initiation of therapy,recovery phase and in deathbed phase were studied.Results 20 of patients with high MELD score （ ≥ 30 ） received （ 14.6 ±14.1 ） days treatment.The difference in MELD score between pre-（ 36.03 ± 5.01 ） and post-treatment （ 39.86 ± 5.95 ） was significant （ t =- 2.994,P =0.007 ）.There was no significant difference in HBV DNA load between pre-[ （ 4.454 ± 1.714 ） copies log1o/ml ] and post-treatment [ （ 3.979 ± 1.947 ） copies log10/ml ] （t =2.212,P =0.051 ）,the mortality was 100% （20/20）.47 of patients with moderate MELD score （22-30） received （51.5 ± 41.6） days treatment.There was no significant difference in MELD score between pre-（25.71 ± 2.47 ） and post-treatment （ 26.18 ± 13.32） （ t =- 0.263,P =0.794）.The difference in MELD score between pre-[ （6.084 ± 1.795） copies log10/ml] and post-treatment [ （3.378 ±2.156） copies log10/ml] was significant （t =7.148,P =0.000）,the mortality was 53.19% （25/47）.34 of patients with low MELD score （≤22） received （67.2 ±40.9） days treatment.The difference in MELD score was significant between pre-（ 18.85 ± 2.72 ） and post-treatment （ 11.68 ± 7.23 ） （ t =5.983,P =0.000）.There was significant difference in HBV DNA load between pre-[ （5.945 ± 1.635）copies log10/ml ]and post-treatment [ （2.725 ± 1.194） copies log10/ml ] （t =9.962,P =0.000）,the mortality was 2.94% （1/34）.Conclusions The ACLF of HBeAg-negative chronic hepatitis B patients with a low score of MELD score （≤22） mostly survive with internal general treatment added entecavir.The mortality of the patients with a MELD score （22-30） is 53.19% （25/47）.The patients with high MELD score （≥30） which almost lack the opportunitv of treatment.is associated with fatal liver failure and need for emergency liver transplantation.
出处
《中华实验和临床病毒学杂志》
CAS
CSCD
北大核心
2011年第6期466-469,共4页
Chinese Journal of Experimental and Clinical Virology
