摘要
目的分析不同病毒载量乙型肝炎(乙肝)肝硬化失代偿期患者的临床特征及转归情况。方法选择我院2008年1月—2011年1月收治的乙肝肝硬化期失代偿期患者183例,根据血清乙型肝炎病毒(HBV)DNA水平分为低病毒载量组67例(<105拷贝/ml)和高病毒载量组116例(≥105拷贝/ml)。两组患者均给予对症支持治疗和抗病毒药物治疗,回顾性分析两组患者的临床资料并记录其转归情况。结果两组患者的性别构成、年龄、肝功能Child-Pugh分级比较,差异均无统计学意义(P>0.05);HBV表面抗原(HBsAg)阳性率比较,差异有统计学意义(P<0.05)。治疗前,两组患者天冬氨酸氨基转移酶(AST)水平、凝血酶原时间(PT)比较,差异均有统计学意义(P<0.05),丙氨酸氨基转移酶(ALT)、清蛋白(ALB)、总胆红素(TBiL)、胆碱酯酶(CHE)、总胆汁酸(TBA)水平比较,差异均无统计学意义(P>0.05);治疗后,两组患者以上指标比较,差异均无统计学意义(P>0.05);低病毒载量组、高病毒载量组患者治疗前后各观察指标比较,差异均有统计学意义(P<0.05)。两组患者死亡率比较,差异无统计学意义(χ2=0.067,P=0.796),原发性肝癌(χ2=8.457,P=0.004)、自发性腹膜炎(χ2=20.461,P=0.000)、消化道出血(χ2=85.331,P=0.000)发生率比较,差异均有统计学意义。结论血清HBV DNA水平并不能直接反映乙肝肝硬化失代偿期患者的病情严重程度,应重视低病毒载量患者的早期治疗,积极应用抗病毒药物。
Objective To analyze the clinical features and prognoses of decompensated liver cirrhosis of hepatitis B with different viral loads. Methods A total of 183 patients with decompensated liver cirrhosis of hepatitis B admitted from Janu- ary 2008 to January 2011 were divided, according to serum hepatitis B virus （HBV） DNA level, into groups low - load （n = 67, 〈 105 copies/ml） and high -load （n = 116, 〉1 105 copies/ml）. Symptomatic and supportive treatment and antiviral ther- apy were given. The clinical data were analyzed retrospectively and the outcome recorded. Results There was no significant difference in gender, age, Child - Pugh degree of liver function between the two groups （P 〉 0. 05 ） ; There was in the positive rate of HBV surface antigens （HBsAg） （ P 〈 0. 05 ）. Before treatment, there was difference in aspartate aminotransferase （AST）, prothrombin time （PT） （P〈0.05）, but there was no in alanine aminotransferase （ALT）, albumen （ALB）, total bilirubin （ TBiL）, cholinesterase （ CHE）, total bile acid （TBA） （ P 〉0. 05 ）. After treatment, there was no difference in a- bove - mentioned indicators （ P 〉 0. 05 ）. There was difference in all observed indicators between pre - and post - treatment in the two groups （ P 〈 0. 05 ）. No significant difference was noted in death rate between the two groups （x2 = 0. 067, P = 0. 796）, there was difference in incidence of primary liver cancer （ x2 = 8.457, P = 0. 004）, spontaneous peritonitis （ X2 = 20. 461, P = 0. 000）, alimentary tract hemorrhage （ X2 = 85.331, P = 0. 000）. Conclusion Serum HBV DNA level can not reflect directly the condition of patients with hepatitis B decompensated liver cirrhosis. Early treatment for patients with low viral load should be paid attention to and antiviral drugs be used positively.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第14期1672-1674,共3页
Chinese General Practice
