恩替卡韦对慢性乙型肝炎伴慢加急性肝衰竭病毒复制、肝功能及凝血功能的影响

摘要

Objective To study the effect of entecavir on viral replication,liver function and coagulation function in patients with chronic hepatitis B(CHB) and acute-on-chronic liver failure(ACLF). Methods Totally 128 patients with CHB and ACLF admitted to our hospital from January 2015 to January 2017 were selected and randomly divided into the control group and the observation group according to the random number table method,64 cases in each group. The control group was treated with Lamivudine Tablets(100 mg/d), while the observation group was treated with Entecavir Dispersible Tablets(500 mg/d),the two groups were continuously treated for 6 months. Results After 6 months of treatment,the MELD score and quantitative HBV-DNA in the observation group were signifi-cantly lower than those in the control group(P < 0. 05). After 1,3,6 months of treatment,the negative rates of HBV-DNA in the ob-servation group were significantly higher than those in control group(P < 0. 05). After treatment,the levels of AST,ALT and TBIL in the observation group were significantly lower than those in the control group,but the levels of ALB and PTA were significantly higher than those in the control group(P < 0. 05). After 12 months of follow-up,the survival rate of the patients in the observation group was significantly higher than that of the control group(P < 0. 05). Conclusion Entecavir in the treatment of CHB and ACLF has good clinical efficacy,it can effectively control the replication of the virus,improve the liver function and coagulation function of the patients, reduce the mortality and MELD score,which is worthy of clinical promotion.%目的 研究恩替卡韦对慢性乙型肝炎(简称乙肝)伴慢加急性肝衰竭患者的病毒DNA复制、肝功能及凝血功能的影响.方法 选取医院2015年1月至2017年1月收治的慢性乙肝伴慢加急性肝衰竭患者128例,采用随机数字表法分为对照组和观察组,各64例.对照组患者口服拉米夫定片(100 mg/d)治疗,观察组患者口服恩替卡韦分散片(500 mg/d)治疗,均连续治疗6个月.结果 连续治疗6个月后,观察组患者的终末期肝病模型(MELD)评分和乙肝病毒脱氧核糖核酸(HBV-DNA)定量均显著低于对照组(P<0.05),治疗1,3,6个月后HBV-DNA转阴率均显著高于对照组(P<0.05);治疗后天门冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平显著低于对照组,白蛋白(ALB)、凝血酶原活动度(PTA)水平显著高于对照组(P<0.05);随访12个月后,观察组患者的生存率显著高于对照组(P<0.05).结论 恩替卡韦治疗慢性乙肝伴慢加急性肝衰竭临床疗效佳,可有效控制病毒复制,改善肝功能及凝血功能,降低病死率和MELD评分,值得临床推广.