CAJ | 학술논문

目的观察拉米夫定治疗慢性乙型肝炎慢加急性肝衰竭(HBV-ACLF)早、中期患者48周的临床疗效及和病毒学应答的关系.方法回顾性分析了73例使用拉米夫定治疗的HBV-ACLF早、中期患者,观察0、4、8、24、48周的凝血酶原时间活动度、ALT、AST、总胆红素、白蛋白、血尿素氮、肌酐、HBV DNA定量、病毒学应答及生存率.使用SPSS17.0软件分析,组间两均数比较用成组t检验,两率间比较用x2检验.结果 (1)在4、8、24、48周时完全病毒学应答率分别为57.5％ (42/73)、71.0％ (44/62)、83.1％ (49/59)、86.5％ (45/52);部分病毒学应答率分别为30.1％ (22/73)、25.8％ (16/62)、16.9％ (10/59)、13.5％ (7/52).(2) 48周时总的生存率为71.2％(52/73)；完全病毒学应答患者、部分病毒学应答患者生存率分别为61.6％ (45/73)、9.6％ (7/73);完全病毒学应答患者的预后优于部分病毒学应答患者,两组比较,x2=6.829,P＜0.01,差异有统计学意义.(3)肝功能、MELD评分,HBV DNA定量在第8、24、48周较基线水平有明显改善.结论拉米夫定治疗HBV-ACLF早、中期患者具有良好的临床疗效,预后与病毒学应答有关.
목적 관찰랍미부정치료만성을형간염만가급성간쇠갈(HBV-ACLF)조、중기환자48주적림상료효급화병독학응답적관계.방법 회고성분석료73례사용랍미부정치료적HBV-ACLF조、중기환자,관찰0、4、8、24、48주적응혈매원시간활동도、ALT、AST、총담홍소、백단백、혈뇨소담、기항、HBV DNA정량、병독학응답급생존솔.사용SPSS17.0연건분석,조간량균수비교용성조t검험,량솔간비교용x2검험.결과 (1)재4、8、24、48주시완전병독학응답솔분별위57.5％ (42/73)、71.0％ (44/62)、83.1％ (49/59)、86.5％ (45/52);부분병독학응답솔분별위30.1％ (22/73)、25.8％ (16/62)、16.9％ (10/59)、13.5％ (7/52).(2) 48주시총적생존솔위71.2％(52/73)；완전병독학응답환자、부분병독학응답환자생존솔분별위61.6％ (45/73)、9.6％ (7/73);완전병독학응답환자적예후우우부분병독학응답환자,량조비교,x2=6.829,P＜0.01,차이유통계학의의.(3)간공능、MELD평분,HBV DNA정량재제8、24、48주교기선수평유명현개선.결론 랍미부정치료HBV-ACLF조、중기환자구유량호적림상료효,예후여병독학응답유관.
Objective To observe the therapeutic effects of lamivudine treatment in patients with earlyto mid-stage hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods Clinical data of 73 hospitalized patients with HBV-ACLF were retrospectively analyzed.Prothrombin time (PT,active coagulation),HBV DNA,and model for end-stage liver disease (MELD) score data from treatment weeks 4,8,24,and 48 were collected and analyzed using the statistical t-test.Results During the treatment duration,the complete virologic response rates were 57.5％ (42/73) at 4 weeks,71.0％ (44/62) at 8 weeks,83.1％ (49/59) at 24 weeks,and 86.5％ (45/52) at 48 weeks.The partial virologic response rates were 30.1％ (22/73) at 4 weeks,25.8％ (16/62) at 8 weeks,17.0％ (10/59) at 24 weeks,and 13.5％ (7/52) at 48 weeks.At week 48,the survival rate was 71.2％ (52/73) and the probability of survival was higher in the complete virological response rate (VRR) group than in the partial VRR group [45/73 (61.6％) vs.7/73 (30.1％),respectively; P=0.000].In addition,there were significant improvements in the serum normalization rate of HBV DNA,alanine aminotransferase,aspartate aminotransferase,albumin,total bilirubin,PT and MELD score in surviving patients compared to baseline (P＜0.05) and in the complete VRR group compared to the partial VRR group (P＜ 0.05).Conclusion Antiviral therapy using lamivudine may be an effective therapeutic option for patients with HBV-ACLF.