不恰当停用核苷类药物后导致重型肝炎的分析

Severe hepatitis resulted from inappropriate use of nucleoside drugs

目的回顾性分析核苷类药物不恰当停用后导致重型肝炎的临床表现、治疗及预后,采取相应的预防措施及处理方法。方法病例选择近四年来我院肝病科收治不恰当停用核苷类药物后导致重型肝炎41例患者,其中肝炎25例,肝硬化16例,予保肝、抗病毒、支持、人工肝等治疗,观察两组患者入院前的TBil、Alb、PTA、HBVDNA、并发症、预后差别。结果肝硬化组患者Alb、PTA、HBVDNA低,常见并发症:水电解质失衡、原发性腹膜炎、肝性脑病多见,病死率高,预后较差;肝炎患者预后相对较好。结论使用核苷类药物患者应加强交流、监督、随访,核苷类药物不恰当停用后应尽快服用高效、快速的抗病毒药物。

Objective To investigate the clinical manifestation,treatment and prognosis of severe hepatitis resulted from the inappropriate usage of nucleoside drugs.Methods A total of 41 cases of severe hepatitis resulted from the inappropriate usage of nucleoside drugs were detected from 2006 to 2010（25 cases of hepatitis and 16 cases of liver cirrhosis）.The patients were treated with protecting liver,anti-virus and supportive artificial liver.The value of TBil,Alb,PTA,HBV DNA,common complications and the prognosis were compared.Results The values of Alb,PTA and HBV DNA were found to be lower.Common complications such as water electrolyte imbalance,primary peritonitis and brain disorder were more common.The mortality rate was higher and the prognosis was worse in liver cirrhosis group compared to the hepatitis group.Conclusion Strengthening patient monitoring and follow-up,prescribing highly effective anti viral drugs as soon as possible after the inappropriate usage of nucleoside drugs is important to avoid severe hepatitis.