肝衰竭程度对拉米夫定治疗HBeAg阴性ACLF生存率的影响

Effect of Liver Failure Degree on Survival Rate in Patients with HBeAg-negative ACLF after Lamivudine Treatment

【目的】探讨在HBeAg阴性慢加急性肝衰竭(ACLF)患者,拉米夫定治疗开始时肝功能衰竭程度对其转归的影响。【方法】分析71例接受拉米夫定+内科基础治疗患者在治疗开始时、治疗后或临终前的MELD值和血清HBV DNA载量,比较不同MELD值范围者生存率。【结果】MELD高分值组(≥31分)25例,治疗开始和临终前MELD值(log10 copies/mL)依次为34±4和39±9,HBV DNA载量分别为5.6±1.9和3.6±1.0;MELD中分值组(23～31分)27例,MELD值(log10copies/mL)由治疗前25±3升至治疗后30±10,HBV DNA载量由5.5±1.8降为3.2±1.1;MELD低分值组(≤23分)19例,MELD值(log10copies/mL)由治疗前19.5±2.0降至治疗后15.7±8.0,HBV DNA载量由6.3±1.6降为3.1±1.0。各组内比较,治疗前后MELD值、HBV DNA载量的差异均有统计学意义(P<0.05)。3组间比较,治疗前后HBV DNA载量的差异均无统计学意义(P>0.05),但患者生存率依次为8.00%(2/25),55.56%(15/27)和84.20%(16/19),组间两两比较的差异均有统计学意义(P<0.05)。【结论】治疗开始的肝衰竭程度显著影响HBeAg阴性ACLF患者拉米夫定+内科基础治疗转归。当MELD值≥31分,生存率低。

[ Objective ] To investigate the effect of pretreatment liver failure degree on the outcome of patients with HBeAg- negative acute-on-chronic liver failure （ACLF） lamivudine treatment. [ Methods ] A total of 71 patients received lamivudine plus basic medical treatments. Their serum HBV DNA loads and MELD scores were statistically analyzed at pretreatment, post-treatment or death before. And the survival rates of different MELD scores ranges were compared. [Results] 25 patients had pretreatment MELD scores above 31, whose MELD scores of pretreatment and before death were 34 ± 4 and 39 ± 9.9, respectively. Meanwhile, HBV-DNA loads were 5.6 ± 1.9 and 3.6± 1.0 log10 copies/mL in order. For 27 patients with pretreatment MELD scores ranged from 23 to 31, their MELD scores increased from 25 ±3 to 30±10 while HBV-DNA loads decreased from 5.5± 1.8 to 3.2 ± 1.1 logl0 copies/mL after treatment. MELD scores decreased from 19.5 ± 2.0 to 15.7 ± 8.0 and HBV-DNA loads decreased from 6.3 ± 1.6 to 3.1 ± 1.0 loglO copies/mL in 19 patients with pretreatment MELD scores below 23. In each group, there were significant differences in MELD scores and HBV DNA loads between pretreatment and post-treatment statistically （P 〈 0.05 ）. Among three groups, no significant difference was found in HBV DNA loads at pretreatment and post-treatment （P 〉 0.05 ）. The survival rates were 8.00% （2/25）, 55.56% （15/ 27）, and 84.20% （16/19） in sequence and there were significant differences （P 〈 0.05 ）. [ Conclusions ] Pretreatment liver failure degree significantly affects the outcome of lamivudine plus basic medical treatment on patients with HBeAg-negative ACLF. For patients with pretreatment MELD score above 31, the survival rate is low.