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)