停用核苷和核苷酸类药物抗HBV后诱发慢加急性肝衰竭的临床特征

胡高飞; 李小鹏; 吴振平; 梅清; 李丹; 张文苑; 余婷婷; 程娜; 张伦理

doi:10.3969/j.issn.1001-5256.2017.07.023

停用核苷和核苷酸类药物抗HBV后诱发慢加急性肝衰竭的临床特征

DOI: 10.3969/j.issn.1001-5256.2017.07.023

南昌大学第一附属医院感染病科江西省肝脏再生医学重点实验室

基金项目:

江西省科技支撑计划社发项目(20151BBG70221)；

详细信息

中图分类号: R512.62;R575.3
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出版历程
- 收稿日期: 2017-01-16
- 出版日期: 2017-07-20

Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues

Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University & Jiangxi Key Laboratory of Liver Regenerative Medicine

Research funding:

摘要

摘要:
目的探讨患者停用核苷和核苷酸类药物（NAs）抗HBV后诱发慢加急性肝衰竭（ACLF）的临床特征。方法回顾性分析2014年6月-2016年10月南昌大学第一附属医院收治的确诊为ACLF的患者865例,其中因停药诱发ACLF的患者137例（停药组）,非停用NAs诱发ACLF的患者728例（非停药组）,详细记录患者抗病毒药物种类、规范抗病毒持续时间、停药方式、停药至发生肝衰竭时间、停药后监测情况、肝脏基础疾病、进展为ACLF后30 d病死率等。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验。结果非停药组728例患者中治愈或好转、死亡或无效分别为389例和339例。137例停药组患者中慢性病毒性肝炎基础69例,其中治愈或好转、死亡或无效分别为40例和29例;肝硬化基础68例,其中治愈或好转、死亡或无效分别为16例和52例,差异有统计学意（χ2=16.81,P<0.001）。137例停药患者中停药前服用拉米夫定占24.09%（33/137）,阿德福韦酯占34.31%（47/137）,拉米夫定联合阿德福韦酯占11.68%（16/137）,...
- 肝功能衰竭 /
- 肝炎病毒,乙型 /
- 核苷类 /
- 核苷酸类
Abstract:
Objective To investigate the clinical features of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) induced by the withdrawal of nucleos (t) ide analogues (NAs) .Methods A retrospective analysis was performed for the clinical data of 865 patients who were admitted to The First Affiliated Hospital of Nanchang University from June 2014 to October 2016 and diagnosed with ACLF.Among these patients, 137 experienced ACLF induced by drug withdrawal (withdrawal group) and 728 experienced ACLF not induced by drug withdrawal (non-withdrawal group) .The type of antiviral drugs, duration of standard antiviral therapy, withdrawal way, time from withdrawal to the development of liver failure, monitoring after withdrawal, underlying liver diseases, and 30-day mortality after progression to ACLF were recorded in detail.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Of all the 728 patients in the non-withdrawal group, 389 were cured or improved and 339 died or had no response.Of all the 137 patients in the withdrawal group, 69 had chronic viral hepatitis, among whom 40 were cured or improved and 29 died or had no response;68 had liver cirrhosis, among whom 16 were cured or improved and 52 died or had no response;there was a significant difference (χ2=16.81, P<0.001) 6="" 16="" 25="" 32="" 33="" 37="" 47="" 79="" 137="" .of="" all="" the="" patients="" in="" withdrawal="" before="" used="" adefovir="" lamivudine="" combined="" with="" and="" entecavir.of="" when="" they="" developed="" had="" a="" duration="" of="" drug="" 6-12="">12 months.Conclusion Improper withdrawal of NAs can easily induce ACLF.The changes in virologic parameters, liver function parameters, and liver imaging findings should be closely monitored for patients with hepatitis B within 6 months after withdrawal.Underlying liver diseases determine the development and prognosis of ACLF after withdrawal, and long-term standard antiviral therapy is of great importance in patients with liver cirrhosis.
- liver failure /
- hepatitis B virus /
- nucleosides /
- nucleotides

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