Objective To evaluate the therapeutic efficacy and its related factors of entecavir treatment for patients with acute on chronic hepatitis B liver failure (ACHBLF).Methods One hundred and eight patients with ACHBLF were enrolled and divided into entecavir group (n=53) and control group (n=55).HBV DNA level, liver function and 48-week survival rate were observed, and C ox regression model was established to identify the factors which may affect the efficacy of entecavir treatment.Results Totally 70 patients died in the study and 66 died within 12 weeks.The statistical difference on cumulative survival rate between two groups was observed from the third week on (χ2=5.357, P ＜ 0.05).The 48-weekcumulative survival rate in entecavir group was 47.2% (25/53), while that in the control group was 23.6%(13/55) (χ2=7.432, P ＜ 0.01).In entecavir group, for patients aged ＜ 40 with serum bilirubin level ＜513 μnol/L and international normalized ratio (INR) ＜ 2.5, the fatality rates decreased 74.9%, 75.3%and 76.0%, respectively.Conclusions Entecavir may improve the survival rate of patients with ACHBLF.Age, serum bilirubin level and INR are major factors related to the therapeutic efficacy.%目的 评价恩替卡韦治疗慢加急性乙型肝炎肝衰竭的疗效以及影响疗效的相关因素.方法 108例慢加急性乙型肝炎肝衰竭患者分为恩替卡韦治疗组(53例)和对照组(55例),观察患者入组后48周内不同时点HBV DNA载量、肝功能以及存活状况,应用Cox regression模型分析影响恩替卡韦疗效的相关因素.结果 恩替卡韦治疗组和对照组共有70例患者死亡,其中66例发生在12周内.从第3周起,两组患者的累计生存率开始显示出统计学差异(88.7% vs.70.9%,χ2=5.357,P＜0.05).恩替卡韦治疗组48周累计存活率为47.2%(25/53),对照组为23.6%(13/55),两组比较差异有统计学意义(χ2=7.432,P＜0.01).恩替卡韦治疗组中,年龄≤40岁、总胆红素(TBil)＜513μmol/L、凝血酶原国际标准化比率(INR)＜2.5的患者死亡的相对危险度分别下降74.9%、75.3%和76.0%.结论 恩替卡韦可明显提高慢加急性乙型肝炎肝衰竭患者的生存率,患者年龄、胆红素水平和凝血功能是影响恩替卡韦疗效的主要因素.
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