抗病毒治疗对乙型肝炎相关慢加急性肝衰竭患者短期生存率的影响

摘要

Objective To investigate the short-term efficacy of antiviral therapy in acute-on-chronic liver failure associated with hepatitis B.Methods A total of 348 patients with acute-on-chronic liver failure associated with hepatitis B,of which 173cases of low viral load(HBV DNA<105copise/ml)and 175 cages of high viral load (HBV DNA≥105copies/ml),were divided into two groups.One was treated with antiviral therapy(LAM or ETV or Ltd)and routine supportive therapy,and the other received supportive therapy only.The clinical features,survival rate and the short-term efficacy of antiviral therapy were compared between the two.Results It sas indicated in Cox regression analysis of multiple factors that antiviral therapy is the favorable factor of affecting pmgnosis.The survival rate of the group receiving antiviral therapy was higer than that of the one in control group in a 24-week observation.In patients with 4 weeks treatment there were statistical significant differences(P≤0.05)in beth the Ievd of TBil in serum and the decreasing amplitude of HBV DNA between the two groups.Also after 24-week therapy the survival rates of the patients with both low and high viral load was higer in the group with antiviral therapy,and that made statistically significant(P≤0.05).Conclusion Antiviral therapy can improve the survival rate of the acute-on-chronic liver failure associated with hepatitis B.And it is also needed in patients with low viral load.%目的 探讨抗病毒治疗对乙型肝炎相关慢加急性肝衰竭患者短期转归的影响.方法 348例乙型肝炎相关慢加急性肝衰竭患者,分为常规治疗组及抗病毒治疗组,抗病毒组在常规内科治疗基础上加用抗病毒药物治疗(拉米夫定、恩替卡韦、替比夫定),比较两组患者临床特征、生存率及抗病毒治疗短期疗效差异.其中低病毒载量组173例(HBV DNA<105拷贝/ml)、高病毒载量组175例(HBV DNA≥105拷贝/ml).结果 多因素Cox回归分析表明抗病毒治疗是影响预后的有利因素.观察24周,抗病毒治疗的乙型肝炎相关慢加急性肝衰竭患者生存率高于常规治疗者(X~2=32.865,P=0.000).在治疗4周存活患者中,抗病毒治疗组的血清总胆红素水平(Tbil)及HBV DNA降幅就高于常规治疗组,比较差异有统计学意义(P<0.05).治疗24周,低病毒载量及高病毒载量患者抗病毒治疗组的生存率均高于常规治疗组,比较差异有统计学意义(P<0.05).结论 抗病毒治疗可提高乙型肝炎相关慢加急性肝衰竭患者的生存率,低病毒载量患者也需抗病毒治疗.