恩替卡韦治疗慢性乙型肝炎肝衰竭的疗效观察

Efficacy of entecavir on liver failure patients with chronic hepatitis B

目的观察恩替卡韦对乙型肝炎慢性肝衰竭患者肝功能及生存率的影响。方法治疗组63例乙型肝炎慢性衰竭患者在常规内科治疗基础上加用恩替卡韦0.5mg/d,对照组58例患者采用常规内科治疗,观察12周内两组患者肝脏生化学指标、凝血酶原活动度(PTA)、HBVDNA低于检测下限的比率并进行随访,比较两组患者的生存率。结果在治疗第4、8、12周时两组患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)均显著下降,但差别无统计学意义。第12周时治疗组PTA较对照组升高,差别具有统计学意义(P<0.05)。治疗4周时治疗组血清HBVDNA水平较对照组明显下降(P<0.05)。治疗第8周、12周时HBVDNA低于检测下限的比率显著高于对照组,差别有统计学意义。随访4年期间,治疗组与对照组存活率分别为57.1%和17.2%,治疗组存活率高于对照组(P<0.01)。采用Kaplan-Meier方法对两组患者进行生存分析,治疗组的生存率高于对照组(P<0.01)。结论在乙型肝炎慢性肝衰竭患者中应用恩替卡韦抗病毒治疗能够改善患者的肝功能,提高患者生存率。

Objective To evaluate the efficacy of entecavir treatment for chronic liver failure patients with hepatitis B.Methods All 63 chronic liver failure patients with hepatitis B were treated with entecavir 0.5 mg daily and other routine drugs.Another 58 hepatitis B patients with chronic liver failure were only treated with routine drugs as control.The liver functions,hepatitis B virus DNA level,prothrombin time activity and the survival rate were observed.Rates were compared by chi-square test and the numeration data were compared by t test.The survival rates were compared by Kaplan-Meier method.Results At the 4th,8th and 12th week after the treatment,ALT and AST decreased significantly in both groups.At the 12th week,the levels of prothrombin time activity（PTA）of treatment group was higher than that in control group（P〈0.05）.Four weeks after the treatment,the HBV DNA reduction in treatment group was higher than that in the control group（P〈0.05）.After 8 and 12 weeks,the rate of patients in treatment group whose HBV DNA was lower than the lowest detection value was higher than that in the control group（P〈0.01）.After 4 years following-up,the survival rate in the treatment group was significantly higher than that in the control group（P〈 0.01）.Conclusions Entecavir for the treatment of chronic liver failure patients with hepatitis B could improve the survival rate and their liver function.