摘要
AIM: To investigate optimal timing for therapeutic efficacy of entecavir for acute-on-chronic hepatitis B liver failure (ACLF-HBV) in hepatitis B e antigen (HBeAg)negative patients. METHODS: A total of 109 inpatients with ACLF-HBV were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University from October 2007 to October 2010. Entecavir 0.5 mg/d was added to each patient's comprehensive therapeutic regimen. Patients were divided into threegroups according to model for end-stage liver disease (MELD) score: high (≥ 30, 20 males and 4 females, mean age 47.8 ± 13.5 years); intermediate (22-30, 49 males and 5 females, 45.9 ± 12.4 years); and low (≤ 22, 28 males and 3 females, 43.4 ± 9.4 years). Statistical analysis were performed using SPSS 11.0 software. Data with normal distribution were expressed as mean ± SD and comparisons were made with Student's t tests. A value of P < 0.05 was considered statistically significant. Viral loads were related exponentially and logarithmic data were used for analysis. RESULTS: For 24 patients with MELD score ≥ 30, treatment lasted 17.2 ± 16.5 d. Scores before and after treatment were significantly different (35.97 ± 4.87 and 40.48 ± 8.17, respectively, t = -2.762, P = 0.011); HBV DNA load was reduced (4.882 ± 1.847 copies log10/mL to 3.685 ± 1.436 copies log10/mL); and mortality rate was 95.83% (23/24). Of 54 patients with scores of 22-30, treatment lasted for 54.0 ± 43.2 d; scores before and after treatment were 25.87 ± 2.33 and 25.82 ± 13.92, respectively (t = -0.030, P = 0.976); HBV DNA load decreased from 6.308 ± 1.607 to 3.473 ± 2.097 copies log10/mL; and mortality was 51.85% (28/54). Of 31 patients with scores ≤ 22, treatment lasted for 66.1 ± 41.9 d; scores before and after treatment were 18.88 ± 2.44 and 12.39 ± 7.80, respectively, (t = 4.860, P = 0.000); HBV DNA load decreased from 5.841 ± 1.734 to 2.657 ± 1.154 copies log10/mL; and mortality was 3.23% (1/31). CONCLUSION: For HBeAg-negative patients with ACLF-HBV, when entecavir was added to comprehensive therapy, a MELD score ≥ 30 predicted very poor prognosis due to fatal liver failure.
AIM： To investigate optimal timing for therapeutic efficacy of entecavir for acute-on-chronic hepatitis B liver failure （ACLF-HBV） in hepatitis B e antigen （HBeAg）negative patients. METHODS： A total of 109 inpatients with ACLF-HBV were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University from October 2007 to October 2010. Entecavir 0.5 mg/d was added to each patient＇s comprehensive therapeutic regimen. Patients were divided into threegroups according to model for end-stage liver disease （MELD） score： high （≥ 30, 20 males and 4 females, mean age 47.8 ± 13.5 years）; intermediate （22-30, 49 males and 5 females, 45.9 ± 12.4 years）; and low （≤ 22, 28 males and 3 females, 43.4 ± 9.4 years）. Statistical analysis were performed using SPSS 11.0 software. Data with normal distribution were expressed as mean ± SD and comparisons were made with Student＇s t tests. A value of P 〈 0.05 was considered statistically significant. Viral loads were related exponentially and logarithmic data were used for analysis. RESULTS： For 24 patients with MELD score ≥ 30, treatment lasted 17.2 ± 16.5 d. Scores before and after treatment were significantly different （35.97 ± 4.87 and 40.48 ± 8.17, respectively, t = -2.762, P = 0.011）; HBV DNA load was reduced （4.882 ± 1.847 copies log10/mL to 3.685 ± 1.436 copies log10/mL）; and mortality rate was 95.83% （23/24）. Of 54 patients with scores of 22-30, treatment lasted for 54.0 ± 43.2 d; scores before and after treatment were 25.87 ± 2.33 and 25.82 ± 13.92, respectively （t = -0.030, P = 0.976）; HBV DNA load decreased from 6.308 ± 1.607 to 3.473 ± 2.097 copies log10/mL; and mortality was 51.85% （28/54）. Of 31 patients with scores ≤ 22, treatment lasted for 66.1 ± 41.9 d; scores before and after treatment were 18.88 ± 2.44 and 12.39 ± 7.80, respectively, （t = 4.860, P = 0.000）; HBV DNA load decreased from 5.841 ± 1.734 to 2.657 ± 1.154 copies log10/mL; and mortality was 3.23% （1/31）. CONCLUSION： For HBeAg-negative patients with ACLF-HBV, when entecavir was added to comprehensive therapy, a MELD score ≥ 30 predicted very poor prognosis due to fatal liver failure.
基金
Grants from the Technology Project Fund of Guangdong Province, China, No. 2010B080701024
The Natural Science Fund of Guangdong Province, No. 10451008901004818
The National Natural Science Foundation of China, No. 30971356
The National Grand Program on Key Infectious Disease in the Treatment and Prevention of Infectious Diseases of AIDS and Viral Hepatitis, China, No. 2012ZX10002007-002
The Medical science and Technology Research Fund of Guangdong Province, China, No. B2011101
