替比夫定与恩替卡韦治疗慢加急性肝衰竭的疗效分析

Comparative study on the therapeutic effects of telbivudine and entecavir on acute-on-chronic liver failure

目的观察替比夫定和恩替卡韦治疗慢加急性肝衰竭临床疗效。方法选择57例乙型肝炎慢加急性肝衰竭患者,替比夫定组28例,使用替比夫定600 mg/d;恩替卡韦组29例,使用恩替卡韦0.5 mg/d。观察指标为肝功能、凝血酶原时间(PT)、HBV DNA,分别于治疗后2、4、6、8、12周取值,因为生存率的问题,肝功能、PT只取2、4、6周进行对比。结果替比夫定组和恩替卡韦组病死率分别为21.43%、48.28%,差异有统计学意义;两组HBV DNA阴转率及时限上相比均不具有统计学意义。两组治疗后PT、胆碱酯酶、TBil、血清白蛋白(Alb)随着治疗时间的延长,均改善,但在治疗后第2、4、6周相同时间点时比较,差异均有统计学意义(P<0.01),替比夫定组改善较恩替卡韦组改善提前。结论替比夫定治疗慢加急性肝衰竭,能有效降低病死率。

Objective To observe the clinical effects of telbivudine and entecavir on acute-on-chronic liver failure.Methods Fifty-seven patients with acute-on-chronic liver failure infected with viral hepatitis B were chosen and divide into 2 groups： the Telbivudine group（of 28 cases） treated with 600 mg Telbivudine /day and the Entecavir group（of 29 cases）treated with 0.5 mg Entecavir /day.The indicators for observation were liver function,prothrombin time（PT） and HBV DNA.The results of observation were taken at the 2,4,6,8 and 12 week respectively after the treatment.Because the survival rate was taken into account,the results of liver function and prothrombin time（PT） was taken at the 2,4,6 week for comparison.Results There was a significant difference in fatality rate between the Telbivudine group（21.43%） and the Entecavir group（48.28%）.Both the negative conversion rate of HBV DNA and the time of negative conversion of the two groups showed no statistical difference.In both the groups,the prothrombin time,the cholinesterase,the serum bilirubin and the serum albumin improved with prolonging the treatment time,and significant statistical difference was observed at the 2,4,6 weeks after the treatment（P〈0.01）,and the above indicators of the patients in the telbivudine group improved earlier than in the entecavir group.Conclusion Telbivudine could decrease the fatality rate of patients with subacute-on-chronic liver failure infected with HBV