目的：探讨加强自我管理对乙型肝炎肝硬化失代偿期患者恩替卡韦抗病毒治疗的依从性及疗效的影响。方法选取2010年1月-2012年1月在福建医科大学附属泉州市第一医院住院使用恩替卡韦抗病毒治疗的乙型肝炎肝硬化失代偿期患者120例，随机分为对照组和干预组各60例。对照组实行常规护理，干预组在对照组基础上定期电话随访宣讲肝硬化失代偿期综合防治的自我管理指导。比较2组1年后停药率、再住院率、HBV DNA 阴转率、原发性肝癌发生率和病死率。计量资料的比较采用 t检验，计数资料的比较采用卡方检验或 Fisher 精确检验。结果干预组停药率和住院率分别为0和18．3％，对照组分别为8．3％和35.0％，2组比较差异有统计学意义（P 值均＜0．05）。干预组 HBV DNA 阴转率、原发性肝癌发生率和病死率分别为90.0％、3.3％、5．3％，对照组分别为88．3％、5％、6．7％，2组比较差异无统计学意义（P 值均＞0．05）。结论加强失代偿期乙型肝炎肝硬化恩替卡韦抗病毒治疗患者的自我管理，并对其经常性的健康宣教可以增加患者的依从性，有利于康复。%Objective To investigate the effect of strengthening self -management on the treatment compliance and outcome in hepatitis B patients with decompensated cirrhosis treated with entecavir.Methods A total of 120 hepatitis B patients with decompensated cirrhosis, who received antiviral therapy with entecavir in our hospital from January 2010 to January 2012,were randomly divided into control group (n=60)and intervention group (n =60).Both groups received routine nursing care;in addition,regular telephone follow -up was performed for the intervention group to provide guidance for the self -management during the comprehensive prevention and treatment of decompensated cirrhosis.The two groups were compared in terms of withdrawal rate,rehospitalization rate,hepatitis B virus (HBV)DNA negative conver-sion rate,incidence of primary liver cancer,and mortality one year later.Continuous data were analyzed by t test,and categorical data by chi -square test or Fisher′s exact test.Results The withdrawal rate and rehospitalization rate in the intervention group were 0 and 18.3%, respectively,versus 8.3% and 35% in the control group (P <0.05 for both).The HBV DNA negative conversion rate,incidence of prima-ry liver cancer,and mortality in the intervention group were 90%,3.3%,and 5.3%,versus 88.3%,5%,and 6.7% in the control group (P >0.05 for all).Conclusion Strengthening self -management,as well as regular health education,can improve treatment compliance and promote recovery in hepatitis B patients with decompensated cirrhosis treated with entecavir.
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