短期抗病毒治疗在慢性重型乙型肝炎中的应用

Short-term antiviral therapy in chronic severe hepatitis B

目的评价慢性重型乙型肝炎(CSHB)患者短期抗病毒治疗的临床效果。方法回顾性分析83例CSHB患者的病历资料:57例采用抗病毒治疗+内科综合治疗+人工肝治疗(组1),26例采用内科综合治疗+人工肝治疗(组2),观察2组患者血清丙氨酸转氨酶(ALT)、总胆红素(TBIL)、凝血酶原时间活动度(PTA)、乙型肝炎病毒(HBV)DNA载量的好转情况。结果经过2～4周的治疗,组1患者ALT、TBIL、PTA、HBV DNA的下降值等与组2比较,差异均有统计学意义(均P<0.05);组1的治疗好转率为78.95%(45/57),组2为57.69%(15/26),两组差异有统计学意义(χ2=4.14,P<0.05)。在组1中,替比夫定与恩替卡韦2种药物治疗好转率分别为69.57%(16/23)和68.42%(13/19),差异无统计学意义(χ2=0.01,P>0.05)。结论抗病毒治疗可提高CSHB的临床治疗效果,尤其可改善早、中期CSHB患者的预后;恩替卡韦、替比夫定均可用于此类患者的治疗。

Objective To ewduate the clinical efficacy of antiviral therapy in patients with chronic severe hepatitis B （CSHB）. Methods Eighvlhree patients with CSHB were divided into 2 groups,57 patients of group 1 （antlviral group） received antiviral treatment plus comprehensive internal medicine treatment and liver support therapy, 26 pa- tients of group 2 （nowantiviral group） received only comprehensive internal medicine treatment plus liver support therapy , the improvement rate of alanine transaminase （ALT）, total bilirubin （TBIL）, prothrombin time activity （PTA）, and HBV DNA load in two groups of patients were observed. Results After 2 - 4 weeks of treatment,the declined values of ALT, TBIL, PTA, and HBV DNA in group 1 were significantly different from group 2 （all P〈 0. 05） ; improvement rate of group 1 and 2 was 78. 95%（45/57） and 57. 69% （15/26） respectively （X2 = 4. 14, P〈 0. 05）. In group 1, treatment efficacy of telbivudine and entecavir was 69. 57%（16/23） and 68. 42%（13/19） respec- tively （X^2 = 0.1）1, P〉0. 05）. Conclusion Antiviral therapy can significantly improve the treatment efficacy of CSHB, early application can improve the prognosis; entecavir and telbivudine can be used for the treatment.