早期病毒学应答对乙型肝炎病毒感染相关肝衰竭患者预后及转归的影响

彭建平; 孙克伟; 伍玉南

早期病毒学应答对乙型肝炎病毒感染相关肝衰竭患者预后及转归的影响

湖南中医药大学第一附属医院传染科

基金项目:

国家十一五科技重大专项(No.2008ZX10005-007)；

详细信息

中图分类号: R575.3
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出版历程
- 出版日期: 2012-10-20

Impact of early virological response to antiviral treatment on the outcomes of hepatitis B-associated liver failure

Research funding:

摘要

摘要:
目的研究在HBV感染相关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。方法选择本院2007年6月至2010年12月住院治疗的HBV感染相关肝衰竭患者152例,在内科综合治疗基础上分别予拉米夫定(LAM)或恩替卡韦(ETV)抗病毒治疗。根据抗病毒治疗第4周时患者HBV DNA是否转阴,将患者分为HBV DNA阴性组和HBV DNA阳性组,比较两组治疗基线情况、治疗第4周时TBil、凝血酶原活动度(PTA)、Alb、MELD评分及治疗终点时两组临床转归,对影响治疗转归的所有因素进行多元Logistic逐步回归分析。结果在治疗第4周时,HBV DNA阴性组TBil水平较HBV DNA阳性组明显降低,两组差异有统计学意义(P=0.000);HBV DNA阴性组PTA较HBV DNA阳性组明显升高,差异有统计学意义(P=0.0001);两组Alb、MELD评分差异无统计学意义。治疗终点时HBV DNA阴性组好转率(74.2%)较HBV DNA阳性组(30.5%)明显升高,差异有统计学意义(χ2=28.15,P=0.0067)。对可能影响治疗转归的因素进行多元Logistic回归分析...
- 肝炎病毒,乙型 /
- 肝功能衰竭
Abstract:
Objective To investigate the impact of early virological response to antiviral treatment on the outcomes of hepatitis B-associated liver failure.Methods One-hundred-and-fifty-two patients with hepatitis B-associated liver failure treated in our hospital from June 2007 to December 2010 were retrospectively enrolled in the study.In addition to standard traditional Chinese medicine therapy (including conventional Hugan soup, JiangMei hepatoprotective treatment, and artificial liver treatment) , all patients were given lamivudine (100 mg/d) or entecavir (0.5 mg/d) .The patients were divided into two groups according to hepatitis B virus (HBV) DNA-negative status (indicating early virological response to treatment) and HBV DNA-positive status at week 4.The levels of total bilirubin (TBil) , prothrombin activity (PTA) , and albumin (Alb) , and the MELD score were determined and compared between the two groups.Treatment outcomes were compared at the end of therapy.The factors that impact on the treatment outcomes were determined by stepwise multivariate logistic regression analysis.Results The patients in the HBV DNA-negative group had significantly lower TBil (P=0.000) but significantly higher PTA (P=0.000) at week 4 of treatment than those in the HBV DNA-positive group.There was no significant difference between the two groups for the Alb level or MELD score.The effective rate of therapy was significantly higher in the HBV DNA-negative group than in the HBV DNA-positive group (74.2% vs 30.5%;χ2=28.15, P=0.0067) .The disease stage and early virological response (occurrence of undetectable HBV DNA at week 4 of treatment) were identified as independent factors impacting treatment outcome.Conclusion The ability for a patient to achieve an early virological response (suppression of viral load) to nucleotide analogue treatment may be an indicator of good prognosis for hepatitis B-associated liver failure.
- hepatitis B virus /
- liver failure

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