恩替卡韦治疗HBeAg阴性慢加急性肝衰竭时机探讨

To investigate the opportunity of Entecavir treatment for HBeAg-negative acute-on-chronic liver failure

目的探索慢加急性肝衰竭严重性评分系统不同评分范围的HBeAg阴性慢加急性肝衰竭在内科综合治疗基础上加用恩替卡韦治疗时机与疗效的关系。方法观察并比较108例不同肝衰竭严重性评分范围HBeAg阴性慢加急性肝衰竭加用恩替卡韦抗HBV开始治疗时、恢复期或临终前的肝衰竭严重性指标、HBVDNA载量、疗程和死亡率。结果肝衰竭严重性评分高评分组（≥12分）19例，治疗前后肝衰竭严重性评分及HBVDNA载量差异均无统计学意义，死亡率为18／19。中上评分组（8—11分）30例，治疗前后肝衰竭严重性评分差异无统计学意义，治疗前后HBVDNA载量差异有统计学意义，死亡率66．67％（20／30）。中下评分组（5～7分）36例，治疗前后肝衰竭严重性评分差异无统计学意义，治疗前后HBVDNA载量差异有统计学意义，死亡率30．56％（11／36）。低评分组（≤4分）23例，治疗前肝衰竭严重性评分较缓解期肝衰竭严重性评分明显下降，差异有统计学意义，治疗前后HBVDNA载量差异有统计学意义，死亡率8．70％（2／23）。结论新颖的肝衰竭评分系统能较清晰地分辨思替卡韦治疗HBeAg阴性慢加急性肝衰竭时机与疗效的关系。

Objective To explore relations between the opportunities and effects of internal general treatment added Entecavir on acute-on-chronic liver failure （ACLF） of HBeAg-negative chronic hepatitis B in different score ranges of acute-on-chronic liver failure severity. Methods A total of 108 ACLF of HBeAg- negative chronic hepatitis B patients with different ACLF severity score were treated with internal general treatment added Enteeavir. The liver failure severity scores, HBV-DNA loads during the initiation of therapy, recovery phase and in deathbed phase, courses of Entecavir administration and mortalities were studied. Results For 19 patients with high ACLF score （ 〉1 12 ） , the difference in ACLF score between pre and post-treatment was not signifieant. The difference in HBV-DNA load between pre and post-treatment was not significant and the mortality was 18/19. For 30 patients with higher intermediate ACLF score （8-11） , the difference in ACLF score between pre and post-treatment was not significant. The difference in HBV- DNA load between pre and post-treatment was significant, and the mortality was 66.67% （20/30）. For 36 patients with lower intermediate ACLF score （5-7） , the difference in ACLF score between pre and post- treatment was not signifieant. The difference in HBV-DNA load between pre and post-treatment was significant, and the mortality was 30. 56% （11/36）. For 23 patients with low ACLF score （~〈 4）, the difference in ACLF seore between pre and post-treatment was significant. The difference in HBV-DNA load between pre and post-treatment was significant, and the mortality was 8.70% （2/23）. Conclusions A novel acute-on-chronic liver failure scoring system can syllabify differentiate the relations between the opportunities and efficacies on the Entecavir treatment for HBeAg-negative ACLF.