抗病毒联合糖皮质激素治疗肝衰竭临床观察

Clinic Observation to the Treatment of Hypohepatia with Antiviral Combining with Glucocorticoid

目的观察拉米夫定或恩替卡韦联合糖皮质激素治疗慢加急性肝衰竭和慢性肝衰竭早期患者的临床疗效及安全性。方法 76例患者随机分为两组,两组均给予综合治疗及抗病毒治疗;治疗组加用强的松。治疗前后观察患者临床表现、好转治愈率,同时检测生化指标、PTA及血清HBV DNA载量,以12周为观察终点。结果两组治疗前与治疗后4周、8周、12周比较,血清ALT、TBIL、TC及PTA明显改善,且治疗组各项指标的改善明显,优于对照组。两组治疗12周后,所有生存病例HBV DNA均转阴(<500 copies/ml);与对照组比较,治疗组的治愈好转率82.5%(33/40)明显高于对照组的61.1%(22/36),(P<0.05),治疗组肝性脑病、肝肾综合征的发生率明显低于对照组(P<0.05)。结论早期应用拉米夫定或恩替卡韦联合糖皮质激素治疗慢加急性肝衰竭和慢性肝衰竭早期患者效果好且可使HBV DNA转阴。

Objective Observe the clinic curative effect and the security to earlier suffierers from acute-on-chronic liver failure and chroic liver failure through using the treatment with lamivudinr or enteeavir combining with glucocorticoid. Methods 76 cases were randomly divided into two groups, both of whom are treated with comprehensive and antiviral therapy while being peroraled prednisone, and then observe the clinic situation and cure rate of those sufferers while testing biochemical indicator, PTA and bloodserum HBV DNA capacity ending with the period of 12 weeks. Results The group with treatment obviously got better after one week＇ s treatment while the one without treatment almost kept the same as before with half got worse. Compa- ring the situation among the forth week,8 weeks and 12 weeks,we found that ALT,TBIL,TC amd PTA are greatly improved with obvious differences（ P~〈0.01 ）. Comparing the group with treatment with the one without treatment in different period of 4 weeks ,8 weeks, and 12 weeks ,we found that all index of the former is greatly improved with obvious differences（ P~〈0.05 ）. In the 4th and 12th week, comparing the serum HBV DNA rate between the two groups ,we did not find statistics significance from the cooperation. （P 〉 0.05 ）. After 12 weeks, all HBV DNA turned darkening （ 〈 500 copies/ml）. Comparing with the other group, the group with treatment had cure rate of 82.5 % （33/40）, higher than the other group of 61.1% （22/36）, with obvious differences（P 〈0.05） and without untoward effect during the treatment. What＇s more, in the group with treatment, the inci- dence rate of hepatic encephalopathy, hepatorenal syndrome is greatly lower than that in the other group. Conclusion The sur- vival rate and safety are greatly improved through early treating sufferets from acute-on-chronic liver failure and chronic liver failure with lamivudine or entecavir combining with glucoconicoid.