恩替卡韦治疗乙型肝炎相关急性肝衰竭疗效和安全性研究

Efficacy and Safety of Entecavir in Patients with Hepatitis B-Associated Acute Liver Failure

目的:通过临床观察,研究乙型肝炎相关急性肝衰竭的综合治疗中恩替卡韦抗病毒治疗的有效性和安全性。方法:本研究前瞻性选取了近18个月住院的15例感染乙型肝炎病毒而明确诊断急性肝衰竭的患者,明确诊断后第一时间给予每日服用恩替卡韦0.5mg抗病毒治疗,定期观察生化及病毒学指标,并予以随访。结果:15名患者中除5例病情恶化死亡,2例行原位肝移植外,其余8例服用恩替卡韦患者痊愈出院并完整随访。所有病人在开始恩替卡韦抗病毒治疗后2个月内生化指标完全正常,HBVDNA低于检测下限,耐受性良好。6个月内有7位患者都发生了血清学转换,一位患者HBsAg始终阳性。结论:通过临床观察进一步证实,对乙肝相关急性肝衰竭患者尽早使用恩替卡韦抗病毒治疗,可以缩短病程,改善预后,甚至避免肝移植。

Objective： Acute hepatitis B virus（HBV） infection is followed by high viral replication rates leading to hepatocyte death and ultimately,in some cases,to acute liver failure（ALF） necessitating liver transplantation.Thus,the objective of our study is to observe the efficacy and safety of entecavir in patients with hepatitis B-associated acute liver failure.Methods： This prospective study（01/2011-06/2012） included 15 patients（3 female and 12 males,median age 33.5 years）.HBV DNA and hepatitis B antigens and antibodies system were detected by ELISA or PCR.All patients received entecavir treatment at 0.5 mg daily after confirmed diagnose.Results： Upon treatment,all observed parameters rapidly decreased and returned to normal values or trace amounts（HBV DNA undetectable） within 2 months in all ofthe 8 cases except 5 cases whose condition deteriorated to die and 2 cases who got orthotopic liver transplantation.A seroconversion to anti-HBs was achieved in 7 out of 8 patients;one patient did not seroconvert.Conclusion： This preliminary series of 8 patients reveals that immediate treatment of HBV-induced ALF with entecavir is well tolerated and beneficially affects the course of the disease,improves prognosis,and even avoids liver transplantation.