乙型肝炎相关慢加急性肝衰竭抗病毒治疗118例临床观察

Clinical Observation of Antiviral Treatmen in 118 Cases of Hepatitis B related Acute on Chronic Liver Failure

目的讨抗病毒治疗对不同分期的乙型肝炎相关慢加急性肝衰竭患者短期预后的影响。方法选取118例乙型肝炎相关慢加急性肝衰竭患者,其中早期患者64例、中期患者42例、晚期患者12例,各期患者分为对照组和试验组,试验组在常规内科治疗和人工肝支持基础上加用抗病毒药物治疗(拉米夫定、恩替卡韦),比较各期患者临床特征、生存率及抗病毒治疗12周疗效差异。结果观察3个月,乙型肝炎相关慢加急性肝衰竭早、中、晚期患者的生存率明显不同(P<0.01)。随着病情的加重,生存率明显下降。不同分期分析,晚期患者对照组及试验组生存率无明显差异(P>0.05),而早中期患者试验组生存率明显高于对照组(P<0.05)。结论抗病毒治疗可提高早中期乙型肝炎相关慢加急性肝衰竭患者的生存率,而对于晚期患者抗病毒治疗对生存率无影响。

Objective To investigate the different efficacy of antiviral treatment in patients with different stages of acute on-chronic hepatitis B liver failure. Methods A total of 118 patients with acute-on-chronic hepatitis B liver failure, were classified to 60 cases of early stage,42 cases of medium stage and 12 cases of later stage. Every stage was divided into two groups, one was treated with antiviral therapy （LAM or ETV ） and routine supportive therapy, artificial liver support system while the control group was treated with supportive therapy and artificial liver support system only. To observe and compare the short-term （12weeks） efficacy of antiviral therapy were difference among three stages. Results There was significant difference in the survival rate among the patients with different stages of acute-on-chronic hepatitis B liver failure （ P 〈 0.05 ）. As the liver function got worse, there was lower survival rate of patients. There was no significant difference in the survival rate between the antiviral therapy group and the control group of later stage （ P 〉 0.05 ）. On the contrary the survival rate of patients in the antiviral therapy group was higher than that in control group of the early and medium stage （ P 〈 0.05 ）. Conclusion Antiviral therapy can significantly improve survival rate of patients of earl and medium stage acute-on-chronic hepatitis B liver failure. Otherwise antiviral therapy have no effect on survival rate of patients of later stage.