摘要
目的研究不同病毒学应答状态对失代偿期乙型肝炎肝硬化患者的远期生存率、肝癌发生率的影响。方法连续纳入2010年9月-2016年9月就诊于徐州医科大学附属医院的失代偿期乙型肝炎肝硬化患者378例,根据其抗病毒治疗期间是否HBV DNA持续不可测,分为持续病毒学应答组(n=243例)和非持续病毒学应答组(n=135例)。并依据应用不同抗病毒药物对患者进行分层。记录其基线资料并随访至终点事件发生或研究终点,记录其死亡、肝细胞癌发生情况。符合正态分布的计量资料2组间比较采用独立样本t检验。不符合正态分布的数据2组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。采用Kaplan-Meier法绘制生存曲线,log-rank检验生存曲线。结果持续病毒学应答组5年肝癌累积发生率明显低于非持续病毒学应答组,差异有统计学意义(7.4%vs 19.3%,χ2=10.627,P=0.001)。持续病毒学应答组5年无肝移植生存率明显高于非持续病毒学应答组,差异有统计学意义(93.4%vs 80.7%,χ2=12.594,P<0.001)。对于持续病毒学应答组,恩替卡韦组和非恩替卡韦组患者,5年无肝移植生存率差异无统计学意义(94.7%vs 90.2%,χ2=1.122,P=0.290),5年肝癌累积发生率差异无统计学意义(6.4%vs 9.7%,χ2=0.552,P=0.458)。对于非持续病毒应答组,恩替卡韦组和非恩替卡韦组患者,5年无肝移植生存率差异无统计学意义(78.4%vs 82.8%,χ2=1.526,P=0.217),5年肝癌累积发生率差异无统计学意义(21.5%vs 17.1%,χ2=1.844,P=0.174)。结论抗病毒治疗可以改善失代偿期乙型肝炎肝硬化患者预后,持续病毒学应答可以降低失代偿期乙型肝炎肝硬化患者的肝癌发生率、延长其生存期。
Objective To investigate the influence of different virologic responses on long-term survival rate and incidence rate of liver cancer in patients with decompensated hepatitis B cirrhosis.Methods A total of 378 patients with decompensated hepatitis B cirrhosis who were admitted to The Affiliated Hospital of Xuzhou Medical University from September 2010 to September 2016 were enrolled,and according to whether HBV DNA was continuously undetectable during antiviral therapy,they were divided into sustained virologic response group with 243 patients and non-sustained virologic response group with 135 patients.The patients were stratified according to the application of different antiviral drugs.Baseline data were recorded and the patients were followed up to the occurrence of end events or study endpoint to record death and hepatocellular carcinoma(HCC).The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used to compare survival rates between groups.Results Compared with the non-sustained virologic response group,the sustained virologic response group had a significantly lower 5-year cumulative incidence rate of HCC(7.4%vs 19.3%,χ2=10.627,P=0.001)and a significantly higher 5-year transplant-free survival rate(93.4%vs 80.7%,χ2=12.594,P<0.001).For the sustained virologic response group,there were no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate(94.7%vs 90.2%,χ2=1.122,P=0.290)and the 5-year cumulative incidence rate of liver cancer(6.4%vs 9.7%,χ2=0.552,P=0.458).For the non-sustained viral response group,there were also no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate(78.4%vs 82.8%,χ2=1.526,P=0.217)and the 5-year cumulative incidence rate of liver cancer(21.5%vs 17.1%,χ2=1.844,P=0.174).Conclusion Antiviral therapy can improve the prognosis of patients with decompensated hepatitis B cirrhosis,and sustained virologic response can reduce the incidence rate of liver cancer and prolong survival time.
作者
嵇笑笑
李丽
傅涓涓
潘修成
JI Xiaoxiao;LI Li;FU Juanjuan(Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第5期1033-1037,共5页
Journal of Clinical Hepatology
基金
十三五艾滋病和病毒性肝炎等重大传染病防治子课题(2018ZX10302-206)。
关键词
乙型肝炎
肝硬化
抗病毒药
持续病毒学应答
预后
hepatitis B
liver cirrhosis
antiviral agents
sustained virologic response
prognosis
