CAJ | 학술논문

目的评价核苷(酸)类似物对失代偿性乙型肝炎肝硬化患者长期预后的影响.方法选取53例失代偿性乙型肝炎肝硬化患者,在常规护肝、对症治疗的同时,每天口服拉米夫定(100 mg/d)、阿德福韦酯(10 mg/d)或恩替卡韦(0.5 mg/d).另选取同时期仅行常规护肝、对症治疗的41例失代偿性乙型肝炎肝硬化患者为对照组.发生肝癌、肝移植、死亡或拒绝继续治疗者停止随访.随访结束时分析比较2组治疗前后血清肝功能指标和Child-Pugh分级的变化及临床结局.结果治疗组ALT、AST、球蛋白(G1b)和TBil均较治疗前下降,A1b及胆碱酯酶(CHE)较治疗前升高,43例(81.1%)患者的Child-Push分级下降.对照组治疗前后ALT、AST、G1b和TBil变化差异无统计学意义,但CHE较治疗前明显降低,差异有统计学意义(t=5.225,P<0.01).2组Child-PuSh分级变化差异有统计学意义(X2=52.16,P<0.01),治疗组明显好于对照组.治疗组与对照组发生肝癌比例分别为0.0%和19.5%,差异有统计学意义(X2=23.07,P<0.01),但在病死率及需要接受肝移植的比例方面2组的差异不明显.结论核苷(酸)类似物长期治疗失代偿性乙型肝炎肝硬化可以改善患者肝功能状况,改善患者的预后,并有可能降低肝癌的发生机会.
목적 평개핵감(산)유사물대실대상성을형간염간경화환자장기예후적영향.방법 선취53례실대상성을형간염간경화환자,재상규호간、대증치료적동시,매천구복랍미부정(100 mg/d)、아덕복위지(10 mg/d)혹은체잡위(0.5 mg/d).령선취동시기부행상규호간、대증치료적41례실대상성을형간염간경화환자위대조조.발생간암、간이식、사망혹거절계속치료자정지수방.수방결속시분석비교2조치료전후혈청간공능지표화Child-Pugh분급적변화급림상결국.결과 치료조ALT、AST、구단백(G1b)화TBil균교치료전하강,A1b급담감지매(CHE)교치료전승고,43례(81.1%)환자적Child-Push분급하강.대조조치료전후ALT、AST、G1b화TBil변화차이무통계학의의,단CHE교치료전명현강저,차이유통계학의의(t=5.225,P<0.01).2조Child-PuSh분급변화차이유통계학의의(X2=52.16,P<0.01),치료조명현호우대조조.치료조여대조조발생간암비례분별위0.0%화19.5%,차이유통계학의의(X2=23.07,P<0.01),단재병사솔급수요접수간이식적비례방면2조적차이불명현.결론 핵감(산)유사물장기치료실대상성을형간염간경화가이개선환자간공능상황,개선환자적예후,병유가능강저간암적발생궤회.
Objective To evaluate the long-term prognosis of patients with HBV-related decompensated cirrhosis after treatment with nucleos (t) ide analogues. Methods Totally 94 patients with HBV-related decompensated cirrhosis were enrolled, 53 in nucleos(t) ide group, 41 in control group, and both received routine treatments. Patients in nucleos (t)ide analogue group also received lamivudine ( 100 mg/d), or adefovir ( 10 mg/d), or entecavir (0.5 rag/d). The follow-up was terminated for those who developed hepatocellular carcinoma, received liver transplantation, died or refused the treatment. Serum biochemical markers, Child-Pugh grades and clinical outcomes were compared between two groups at the end of following up. Results After nucleos (t) ide analogues therapy, ALT, AST, globulin ( Glb), and TBil decreased, while Alb and cholinesterase (CHE) increased in the nucleos(t)ide group, and Chiid-Pugh scores decreased in 43 (81.1%) patients. While in the control group, ALT, AST, Glb and TBil did not show significant changes, but the CHE was significantly lower than before ( t = 5. 225, P < 0. 01 ). More patients in nucleos (t)ide group showed improvements in Child-Pugh grades, and there was significant difference between the two groups (X2 = 52.16, P <0.01). The incidence of HCC is lower in nucleos(t) ide group (0%) than that in the control group ( 19.5% ) ( X2 = 23.07, P < 0.01 ). The incidence of death and liver transplantation between two groups did not show siguificant difference. Conclusions Nucleos(t) ide analogues therapy can significantly improve biochemical status of liver functions in patients with HBV-related decompensated cirrhosis. The incidence of hepatocellular carcinoma may decline and the long-term prognosis can be improved.