CAJ | 학술논문

目的探讨慢加急性乙型肝炎肝衰竭患者最优化的临床治疗方案.方法收集2008年1月-2010年1月在福建医科大学附属传染病医院住院治疗的302例慢加急性乙型肝炎肝衰竭患者,所有患者分为A组(内科治疗)57例,B组(内科+抗病毒治疗)80例,C组(内科+抗病毒+人工肝治疗)124例,D组(内科+抗病毒+人工肝+中医治疗)41例.观察患者治疗基线、治疗第1、4、8、12周及治疗结束时的肝功能、肾功能、凝血酶原活动度(PTA)、HBV DNA等指标,并在治疗结束后随访48周观察其存活情况.应用Kruskal-Willis H检验比较治疗后的临床疗效,应用Cox比例风险回归模型进行生存分析.结果治疗4周后四组间的临床疗效差异无统计学意义(H=3.213,P=0.360),治疗12周后的临床疗效差异有统计学意义(H=8.722,P=0.033).四组1年病死率分别为36.84％(21/57)、32.50％(26/80)、26.61％ (33/124)和24.39％(10/41).C组治疗方法的死亡风险是B组的0.566倍(P =0.036)；D组治疗方法的死亡风险是B组的0.396倍(P=0.016).结论在内科治疗的基础上加用核苷(酸)类药物及人工肝单纯血浆置换术可明显提高慢加急性乙型肝炎肝衰竭患者的生存率.
목적 탐토만가급성을형간염간쇠갈환자최우화적림상치료방안.방법 수집2008년1월-2010년1월재복건의과대학부속전염병의원주원치료적302례만가급성을형간염간쇠갈환자,소유환자분위A조(내과치료)57례,B조(내과+항병독치료)80례,C조(내과+항병독+인공간치료)124례,D조(내과+항병독+인공간+중의치료)41례.관찰환자치료기선、치료제1、4、8、12주급치료결속시적간공능、신공능、응혈매원활동도(PTA)、HBV DNA등지표,병재치료결속후수방48주관찰기존활정황.응용Kruskal-Willis H검험비교치료후적림상료효,응용Cox비례풍험회귀모형진행생존분석.결과 치료4주후사조간적림상료효차이무통계학의의(H=3.213,P=0.360),치료12주후적림상료효차이유통계학의의(H=8.722,P=0.033).사조1년병사솔분별위36.84％(21/57)、32.50％(26/80)、26.61％ (33/124)화24.39％(10/41).C조치료방법적사망풍험시B조적0.566배(P =0.036)；D조치료방법적사망풍험시B조적0.396배(P=0.016).결론 재내과치료적기출상가용핵감(산)류약물급인공간단순혈장치환술가명현제고만가급성을형간염간쇠갈환자적생존솔.
Objective To investigate the optimal therapy for patients with acute-on-chronic liver failure induced by hepatitis B.Methods A total of 302 patients with acute-on-chronic liver failure induced by hepatitis B in the Affiliated Infectious Diseases Hospital of Fujian Medical University were enrolled during January 2008 to January 2010.Patients were divided into group A ( medical treatment,n =57 ),group B (medical + antiviral treatment,n =80),group C ( medical + antiviral + artificial liver support system (ALSS),n =124) and group D (medical + antiviral + ALSS + traditional Chinese medicine treatment,n =41 ).Liver and renal function,prothrombin activity (PTA) and HBV DNA load were observed at the baseline,week 1,4,8,12 and the end of the treatment.All groups were followed up for 48 weeks to observe the survival rates.Kruskal-Willis H test was used to compare the efficacies in four groups,and Cox proportional hazards regression model was used for survival analysis. Results There was no difference among four groups in curative effects at week 4 ( H =3.213,P =0.360 ),but there was significant difference at week 12 (H =8.722,P =0.033).The one-year mortality rates for groups A,B,C,D were 36.84％ (21/57),32.50％ (26/80),26.61％ (33/124) and 24.39％ ( 10/41 ),respectively.The death risks of group C and D were 0.566 and 0.396 times of that in group B ( P =0.036 and 0.016).Conclusion Nucleoside analogue and ALSS plus medical treatment can effectively increase the survival rates of the patients with acute-on-chronic liver failure induced by hepatitis B.