HBeAg阴性慢性乙型重型肝炎患者临床特征及抗病毒治疗后生存分析

The clinic features and the short-term efficacy of antiviral treatment on patients with HBeAg negative chronic severe hepatitis B

目的 探讨HBeAg阴性慢性乙型重型肝炎的临床特征及抗病毒治疗对生存率的影响。方法慢性乙型重型肝炎患者HBeAg阴性252例，HBeAg阳性者100例，分常规治疗组及抗病毒治疗组，抗病毒治疗组在常规治疗上加用抗病毒药物（拉米夫定、恩替卡韦、替比夫定），比较两组临床特征及24周生存率。结果HBeAg阴性慢性乙型重型肝炎患者的平均年龄、血清总胆红素高于HBeAg阳性者，丙氨酸转氨酶、天冬氨酸转氨酶、基线HBVDNA水平较低，并发肝性脑病及原发性腹膜炎的比例较高。观察24周，HBeAg阴性者与HBeAg阳性者的存活率无差异（P〉0．05）。HBeAg阴性者抗病毒治疗组的生存率高于常规治疗组（P〈0．05），结论HBeAg阴性慢性乙型重型肝炎患者的临床特征与HBeAg阳性者不同，但短期生存率无差异。抗病毒治疗可提高HBeAg阴性慢性乙型重型肝炎患者的短期生存率。

Objective To investigate the clinic features and the short-term efficacy of antiviral treatment on patients with HBeAg negative chronic severe hepatitis B. Methods 252 HBeAg negative and 100 HBeAg positive patients with chronic severe hepatitis B were rolled. The patients were divided into two groups, one was with antiviral therapy（LAM or ETV or Ltd）and routine supportive therapy, and the control group received supportive therapy only. The clinical features and the short-term（24 weeks） efficacy of antiviral therapy were compared. Resuits The age, total bilinibin and the incidence rates of hepatic encephalapathy and spontaneous peritonitis of HBeAg negative patients were significantly higher, otherwise the alanine aminotransferase, aspartate aminotransferase and the viral load were lower. There was no significant difference in the mortality between the HBeAg nega- tive and HBeAg positive patients（ P 〉0. 05）. The survival rate of patients in the antiviral therapy group was higher than that in control group of the HBeAg negative patients （P 〈 0. 05 ）. Conclusion There was difference in the clinic features between the HBeAg negative and HBeAg positive patients with chronic severe hepatitis B. The antiviral therapy significantly improves survival rate of patients of the HBeAg negative patients.