恩替卡韦早期抗病毒治疗对乙型肝炎相关慢加急性肝衰竭转归的影响

肝脏 ›› 2018, Vol. 23 ›› Issue (10): 873-877.

恩替卡韦早期抗病毒治疗对乙型肝炎相关慢加急性肝衰竭转归的影响

戴金津, 朱传武, 蔡伟, 陈璐

234000 安徽省宿州市立医院感染科(戴金津 2017年在瑞金医院感染科进修);上海交通大学医学院附属瑞金医院感染科(蔡伟,陈璐);苏州第五人民医院感染科(朱传武)

收稿日期:2018-05-21 出版日期:2018-10-31 发布日期:2020-05-21
通讯作者: 陈璐,Email: cl11994@rjh.com.cn
基金资助:
国家自然基金(2014ZX10002002);十三五重大新药创制(2017ZX09304016);上海市公共卫生三年行动计划重点学科建设项目传染病与卫生微生物学(15GWZK0102);上海市临床技能与临床创新能力三年行动计划(16CR1002A);苏州市临床医学专家团队项目(SZYJTD201717)

Efficacy of entecavir in patients with hepatitis B virus related acute-on-chronic liver failure

DAI Jin-jin, ZHU Chuan-wu, CAI Wei, CHEN Lu.

Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Department of Infectious Diseases, SuZhou Municipal Hospital, An Hui 234000, China.
Department of Infectious Disease, the Fifth People’s Hospital of Suzhou, Jiangsu 215000, China

Received:2018-05-21 Online:2018-10-31 Published:2020-05-21
Contact: CHEN Lu, Email: cl11994@rjh.com.cn

摘要/Abstract

摘要： 目的观察恩替卡韦(ETV)早期抗病毒治疗对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者的疗效及短期预后的影响。方法回顾性分析2012年1月至2017年11月于上海交通大学医学院附属瑞金医院感染科住院的HBV-ACLF患者235例,在内科综合治疗的基础上,ETV,0.5 mg/d治疗113例,拉米夫定(LAM),100 mg/d治疗122例,比较两组患者基线、治疗1、2、4、12周时血清生化、凝血功能及HBV DNA载量,临床特征及转归。结果 ETV组和LAM组患者基线特征无明显差异,年龄:49.4比45.7 岁,ALT:1170比1172 U/mL, AST:932比904 U/mL, HBV DNA:5.27×10⁷比5.8×10⁷ IU/mL(均P＞0.05)。治疗结束生化指标及HBV DNA下降率(HBV DNA:2.96比2.95 lg拷贝/mL,P>0.05)均差异无统计学意义。采用Kaplan-Meier方法对两组患者进行生存分析发现,MELD评分>20分或并发症多于2种的患者治疗1周时,ETV组与LAM组相比,生存率显著升高(95.7%比81.7%,P<0.05)。治疗4周、12周时两组生存率差异无统计学意义(69.0%比65.2%,36.6%比46.4%,均P>0.05)。基线PTA及有无肝硬化对两组生存率影响均差异无统计学意义。ETV组和LAM组在治疗终点时的有效率亦差异无统计学意义(33.6%比40.2%,P>0.05)。结论 ETV对HBV-ACLF患者的早期抗病毒治疗有利于患者早期生存率的提高。

关键词: 肝功能衰竭;乙型肝炎;恩替卡韦;拉米夫定

Abstract: Objective To evaluate the efficacy of entecavir (ETV) in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).OMethods Clinical data of 235 HBV-ACLF patients hospitalized in Ruijin Hospital from January 2012 to November 2017 were collected and analyzed. All patients received nucleos(t)ide analogues (NA) treatment besides internal medicine therapy, including the control group receiving lamivudine (LAM) 100 mg/d and the treatment group receiving ETV 0.5mg/d. Serum biochemistry, prothrombin time activity (PTA) and hepatitis B virus (HBV) DNA load were detected before and after NA treatment (at baseline, week 1, 2, 4 and 12). Clinical features and treatment outcomes were compared between the 2 groups. Results Baseline characteristics showed no statistical difference between ETV and LAM groups (age: 49.4 vs. 45.7 years old, alanine transaminase: 1170 vs. 1172 IU/mL, aspartate aminotransferase: 932 vs. 904 IU/mL, HBV DNA: 5.27×10⁷ vs. 5.8×10⁷ IU/mL, P>0.05). After NA treatment, levels of biochemical indexes and HBV DNA declined (HBV DNA: 2.96 vs. 2.95 lg copies/mL, P>0.05). For patients with MELD score > 20 or severe complications ≥ 2 at baseline, survival analysis revealed that ETV group had significantly higher survival rate than LAM group at week 1 (95.7% vs. 81.7%, P<0.05), while no statistical difference at week 4 and 12 (week 4: 69.0% vs. 65.2%, week 12: 36.6% vs. 46.4%, both P>0.05). PTA and cirrhosis statue showed no obvious effect on survival rate of the 2 groups. Furthermore, there was no significant difference in the effective rate between 2 groups at the end of treatment (33.6%/40.2%, P>0.05). Conclusion ETV is beneficial for the improvement of short-term survival rate (at week 1) in severe HBV-ACLF patients (MELD score>20 or complications ≥ 2).

Key words: Liver failure; Hepatitis B; Lamivudine (LAM); Entecavir (ETV)

戴金津, 朱传武, 蔡伟, 陈璐. 恩替卡韦早期抗病毒治疗对乙型肝炎相关慢加急性肝衰竭转归的影响[J]. 肝脏, 2018, 23(10): 873-877.

DAI Jin-jin, ZHU Chuan-wu, CAI Wei, CHEN Lu.. Efficacy of entecavir in patients with hepatitis B virus related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2018, 23(10): 873-877.

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