核苷(酸)类似物治疗乙型肝炎慢加急性肝衰竭患者疗效观察

Effects of nucleoside analogues on acute-on-chronic liver failure in patients with HBV

目的:探讨核苷类似物对乙型肝炎慢加急性肝功能衰竭患者临床转归的影响。方法:本研究回顾性分析了2011年1月至2012年8月我院收治的51例慢性乙型肝炎慢加急性肝功能衰竭患者,分为2组,对照组(拒绝接受核苷类似物,n=12)和治疗组(核苷类似物治疗组,n=39,分别给予拉米夫定、恩替卡韦、替比夫定),比较两组患者病毒学指标以及血清转氨酶,胆红素和MELD评分的变化;综合评估患者临床转归。结果:结束住院治疗时,治疗组20例病情明显好转,表现为血清转氨酶以及胆红素明显下降,MELD评分降低,疗效明显优于对照组(χ2=4.48,P<0.05);但3种药物(拉、恩、替)之间疗效无明显差异(P均>0.05)。结论:使用强效快速类核苷类似物能显著延缓乙型肝炎慢加急性肝功能衰竭病情进展。

Objective： To investigate the effects of nucleoside analogues on acute-on-chronic liver failure （ACLF） in pa- tients with HBV. Methods： Fifty-one patients with acnte-on-chronic liver failure by HBV infection from January 2011 to August 2012 were included in this study. Patients were divided into two groups ： patients agreed to receive nueleoside analogues （ lamivu- dine, enteeavir or telbivudine） were enrolled into treatment group （n = 39 ）, others were enrolled into control group （n = 12） . The serum levels of HBV DNA, ALT, bilirubin, creatinine and MELD score were monitored. The progression of liver disease was evaluated. Results： The liver disease status in 20 patients from treatment group was significantly improved characterized by a de- crease in serum ALT and serum bilirubin level and MELD score, nucleoside analogues could remarkably improve the progression of ACLF compared with control group （χ2 = 4. 48, P 〈 0. 05 ）, however, there was no significant difference among the three treatments （ P 〉 0. 05 respectively） . Conclusion： This study suggests that nueleoside analogues have beneficial effects on acute- on-chronic liver failure in patients with HBV.