中西医结合治疗方案干预乙型肝炎病毒相关慢加急性肝衰竭的疗效分析

Study on the intervention of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure

目的:比较中西医结合治疗与单纯西药治疗方案对48周乙型肝炎病毒(HBV)相关慢加急性肝衰竭(ACLF)患者病死率的影响。方法:934例HBV-ACLF患者为研究对象,按照实际接受的治疗方案分为中西医结合治疗组(593例)、西药治疗组(341例),采用Kaplan-Meier方法及log-rank检验比较两组患者4、8、12、24、48周终点事件累积发生率,通过Cox比例风险回归计算分析影响HBV ACLF预后的独立因素。结果:中西医结合治疗组患者4、8、12、24、48周病死率分别为11.6%、17.9%、20.6%、24.5%、27.0%,显著低于西药治疗组的19.1%、25.5%、27.3%、31.4%、32.0%(P<0.05);经校正混杂因素后,中西医结合治疗组患者4、8、12、24、48周时死亡风险分别是西药组的0.57、0.63、0.72、0.65、0.73倍(P<0.05);年龄、总胆红素、国际标准化比值、肝性脑病、肝肾综合征、血小板计数是影响HBV ACLF预后的独立因素。结论:中西医结合治疗方案能降低HBV-ACLF人群的4~48周病死率;与西药治疗方案相比,中西医结合治疗方案在改善HBV-ACLF患者预后方面具有优势作用。

Objective:To investigate the effects of the integrated Traditional Chinese Medicine(TCM) for the treatment of hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:We performed an analysis of the "Study on HBV-ACLF treated with integrated Traditional Chinese Medicine and western medicine". According to the actual therapy, HBV-ACLF patients were divided into the TCM group and the western medicine(WM) group. Compared the 48-week mortality rate of patients in the two groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier method and the log-rank test were used for survival analysis;the Cox proportional hazards regression model was used for the evaluation of HR and adjusted HR.Results: The mortality rates of patients in TCM group(11.6%, 17.9%, 20.6%, 24.5%, 27%) were significantly lower than those in the WM group(19.1%, 25.5%, 27.3%, 31.4%, 32%) at 4 weeks, 8 weeks, 12 weeks, 24 weeks and 48 weeks(P<0.05). The relative mortality risks of patients in TCM group, compared with those in WM group were respectively 0.57, 0.63, 0.72, 0.65, 0.73(P<0.05). Age, serum bilirubin, international normalized ratio, hepatic encephalopathy, hepatic renal syndrome, and platelet count were independent prognostic factors.Conclusion:Our study proved that the integrated TCM and WM could decease the mortality rate of HBV-ACLF patients. The integrated TCM and WM used for the treatment of HBV-ACLF patients was useful.