拉米夫定、恩替卡韦治疗HBeAg阴性慢加急性肝功能衰竭疗效比较

Lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure

目的评价在不同肝功能衰竭程度下使用拉米夫定与恩替卡韦治疗HBeAg阴性慢加急性肝功能衰竭（ACLF）的短期疗效。方法回顾性分析HBeAg阴性ACLF患者165例，其中应用拉米夫定（100mg／d）治疗72例，应用恩替卡韦（0．5mg／d）治疗93例。观察患者生物化学指标、终末期肝病模型（MELD）值、HBVDNA载量和病死率，比较两药在不同肝功能衰竭程度患者疗效的差异。率的比较采用y。检验，计量资料比较采用t检验。结果治疗前MELD值〉30分患者，拉米夫定与恩替卡韦治疗后HBVDNA分别为（3．6±1．1）lg拷贝／mL和（3．7±1．4）lg拷贝／mL（t=0．181，P=0．859）；病死率分别为92．0％和91．8％（X^2=0．002，P=0．680）。治疗前MELD值为23-30分患者，拉米夫定与恩替卡韦治疗后HBVDNA分别为（3．2±1．1）lg拷贝／mL和（3．2±2．3）lg拷贝／mL（t=0．760，P=0．455）；病死率分别为42．9％和54．1％（X^2=0．799，P=0．455）。治疗前MELD值〈23分患者，拉米夫定与恩替卡韦治疗后HBVDNA分别为（3．1±1．0）lg拷贝／mL和（2．8±1．5）lg拷贝／mL（t=0．740，P=0．464）；病死率分别为3／19和6．3％（X^2=1．227，P=0．455）。治疗前不同MELD值范围患者的病死率比较，拉米夫定组（X^2=26．967，P=0．000）、恩替卡韦组（X^2=41．260，P=0．000）组内差异均有统计学意义。结论患者治疗前的肝功能衰竭程度相似时，拉米夫定与恩替卡韦治疗HBeAg阴性ACLF的短期疗效相当，且不同肝功能衰竭程度显著影响两药治疗后患者的转归。

Objective To evaluate the short-term efficacy of lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure （ACLF） with different pretreatraent liver failure degrees. Methods A total of patients with HBeAg-negative ACLF were enrolled into this retrospective study. Seventy＇two cases were treated with lamivudine 100 mg daily, while 93 cases were treated with entecavir 0. 5 rag daily. Biochemical items, model for end-stage liver disease （MELD） score, hepatitis B virus （HBV） DNA level and mortality were observed. The efficacies of the two drugs were analyzed in patients with different degrees of liver failure. The comparison of rates was done using chi-square test and the raeasureraent data were compared by t test. Results Among the patients with pretreatment MELD scores above 30, the post-treatment HBV DNA levels in lamivudinegroup and entecavir group were （3. 6±1. 1） lg copy/mL and （3.7 ± 1.4） lg copy/mL, respectively （t=0. 181, P=0. 859） and the mortalities were 92.0% and 91.8%, respectively （Z2 =0. 002, P= 0. 680）. For the patients with pretreatment MELD scores from 23 to 30, the post-treatment HBV DNA levels in two groups were （3.2±1.1） lg copy/mL and （3.2±2.3） lg copy/mL, respectively （t=0.760, P=0. 455） and the mortalities were 42. 9%, 54. 1%, respectively （Z2=0. 799, P= 0.455）. In patients with pretreatment MELD scores below 23, the post-treatment HBV DNA levels in two groups were （3.1±1. 0） lg eopy/mL and （2.8±1. 5） lg copy/mL, respectively （t=0. 740, P=0.464） and the mortalities were 3/19 and 6. 3%, respectively （Z2 = 1. 227, P=0. 455）. In lamivudine group, the mortalities were significantly different among patients with three different ranges of pretreatment MELD scores （X^2 = 26. 967, P = 0. 000）. The similar differences were also found in entecavir group （X^2 = 41. 260, P=0. 000）. Conclusions Among treatment naive patients with HBeAg-negative ACLF, the short-term efficacy of lamivudine versus entecavir is equal if the degree of pretreatment liver failure is similar. Meanwhile, the degrees of pretreatment liver failure significantly affects the outcome of the treatment.