核苷类抗病毒药物对慢性重型乙型肝炎的近期疗效分析

Short-term efficacy of antiviral therapy with nucleoside analogues on chronic severe hepatitis B

目的探讨抗病毒治疗对慢性重型乙型肝炎转归的近期影响。方法收集慢性重型乙型肝炎病例。选取54例患者为抗病毒治疗组,选取历史病例67例为对照组。抗病毒治疗组在常规内科治疗基础上加用抗病毒药物治疗(拉米夫定、恩替卡韦、替比夫定),对照组仅使用内科常规治疗。分析两组患者在不同时间点病死率、HBV-DNA水平、PT及肝功能结果。结果治疗1个月后,2组死亡率差异无统计学意义(P>0.05)。治疗3个月后,抗病毒治疗组死亡15例(27.8%),对照组死亡32例(47.8%),两组比较差异有统计学意义(P<0.05)。两组出院患者治疗1个月时ALT、AST、TBIL、PT差异无统计学意义(P>0.05);抗病毒治疗组HBV DNA水平低于对照组,两组比较差异有统计学意义(P<0.05)。治疗3个月后抗病毒治疗组ALT、AST、TBIL、PT、HBV DNA水平明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论抗病毒治疗可降低慢性重型乙型肝炎患者的死亡率,促进肝功能好转,有效抑制病毒复制,能改善慢性重型乙型肝炎患者预后。

Objective To investigate the short-term efficacy of antiviral treatment in patients with chronic severe hepatitis B. Methods Patients with chronic severe hepatitis B were collected. Antiviral treatment group （54 cases） was treated with antiviral therapy（LAM or ETV or Ltd） and conventionally supportive therapy, and the control group（67 historical cases） was treated with supportive therapy only. The mortality, level of hepatitis B virus DNA（HBV-DNA）, prothrombin time （PT） and liver function between the two groups in different points of time were compared. Results The mortality between 2 groups a month after treatment showed no significant difference in （P〉 0.05）. But 3 months after treatment, 15 patients in antiviral treatment group died （27.8%）, while 32 patients （47.8%）in control group died,showed statistically significant deffferenee（P〈 0.05）. The levels of ALT, AST,TBIL and PT between the 2 groups did not show significant difference a month after treatment（P〉 0.05）, but the level of HBV DNA in antiviral treatment group was much lower than in control group （P〈 0.05 ）. The levels of ALT,AST,TBIL and PT and the level of HBV DNA in antiviral treatment group were all lower than those of control group 3 months after treatment （P〈0.05）. Conclusion Antiviral treatment can reducee mortality, improve liver function, inhibit viral replication, with a positive therapeutic effect.