CAJ | 학술논문

目的研究在乙型肝炎相关慢加急性肝衰竭抗病毒治疗过程中早期快速病毒学应答对治疗转归的影响.方法回顾性分析我院2008年1月-2010年7月的乙型肝炎相关慢加急性肝衰竭患者106例,在内科综合治疗基础上,分别给予拉米夫定(l00 mg/d)或恩替卡韦(0.5 mg/d)抗病毒治疗,在治疗基线和第4周检测患者生物化学、凝血功能和HBV DNA载量,根据第4周的HBV DNA载量分为HBVDNA阳性组和阴性组,比较两组间临床特征和治疗转归的差别.用x2检验或Fiisher精确概率法比较率,用独立样本t检验比较均数,对影响治疗转归的所有因素进行多元logistic逐步回归分析.结果治疗第4周时,HBV DNA阳性和阴性组TBil分别为(261.6±205.6)μmol/L、(160.1±173.4)μmol/L,两组比较,t=2.190,P＜0.05,差异有统计学意义.两组PTA分别为44.7％±19.7％、56.8％±23.1％,两组比较,t= -2.077,P＜0.05,差异有统计学意义.HBV DNA阳性组和阴性组在治疗终点时的治疗无效率分别为50％ (9/18)、14.8％ (13/88),两组比较x2=9.235,P＜0.01,差异有统计学意义.病情分期(早、中、晚期)影响治疗转归的OR值为6.559,95％可信区间为2.316 ～ 18.576;HBV DNA阴转影响治疗转归的OR值为0.209,95％可信区间为0.058 ～ 0.747.结论核苷类似物对病毒的快速抑制可提高乙型肝炎相关慢加急性肝衰竭的疗效,治疗4周内的早期病毒学应答有助于判断疾病预后.
목적 연구재을형간염상관만가급성간쇠갈항병독치료과정중조기쾌속병독학응답대치료전귀적영향.방법 회고성분석아원2008년1월-2010년7월적을형간염상관만가급성간쇠갈환자106례,재내과종합치료기출상,분별급여랍미부정(l00 mg/d)혹은체잡위(0.5 mg/d)항병독치료,재치료기선화제4주검측환자생물화학、응혈공능화HBV DNA재량,근거제4주적HBV DNA재량분위HBVDNA양성조화음성조,비교량조간림상특정화치료전귀적차별.용x2검험혹Fiisher정학개솔법비교솔,용독립양본t검험비교균수,대영향치료전귀적소유인소진행다원logistic축보회귀분석.결과 치료제4주시,HBV DNA양성화음성조TBil분별위(261.6±205.6)μmol/L、(160.1±173.4)μmol/L,량조비교,t=2.190,P＜0.05,차이유통계학의의.량조PTA분별위44.7％±19.7％、56.8％±23.1％,량조비교,t= -2.077,P＜0.05,차이유통계학의의.HBV DNA양성조화음성조재치료종점시적치료무효솔분별위50％ (9/18)、14.8％ (13/88),량조비교x2=9.235,P＜0.01,차이유통계학의의.병정분기(조、중、만기)영향치료전귀적OR치위6.559,95％가신구간위2.316 ～ 18.576;HBV DNA음전영향치료전귀적OR치위0.209,95％가신구간위0.058 ～ 0.747.결론 핵감유사물대병독적쾌속억제가제고을형간염상관만가급성간쇠갈적료효,치료4주내적조기병독학응답유조우판단질병예후.
Objective To investigate the impact of early rapid virological response on the outcomes of hepatitis B associated acute on chronic liver failure during antiviral treatment.Methods 106 acute on chronic liver failure patients in our hospital from January 2008 to July 2010 were enrolled in present study retrospectively.Besides internal medicine therapy,all patients received lamivudine (100 mg/d) or entecavir (0.5 mg/d) treatment.The profile of liver biochemistry,prothrombin time activity and viral load were detected at baseline and week 4,respectively.The patients were divided into HBV DNA negative group and HBV DNA positive group according to the viral load at week 4.The clinical features and treatment outcomes were compared between groups.Frequency variables were compared by x2 test or Fisher's exact test.Continuous variables were compared using independent samples T-test.The factors that impact on the treatment outcomes were determined using stepwise multivariate logistic regression analysis.Results At the week 4,the TBil and PTA in HBV DNA positive group ｛(261.6 + 205.6) μ mol/L and 44.7％ + 19.7％,respectively ｝ were significantly different from those in HBV DNA negative group ｛(160.1 ± 173.4) μ mol/L and 56.8％±23.1％,respectively｝ (t = 2.190 and -2.077,respectively,P ＜ 0.05).The non-effective rate of HBVDNA positive group (50％,9/18) was significantly higher than that of HBV DNA negative group (14.8％,13/88) (x2= 9.235,P＜ 0.01).By using stepwise multivariate logistic regression analysis,the disease stage and HBVDNA undetectable at week 4 were the independent factor.The OR values of disease stage and HBV DNA undetectable were 6.559 and 0.209,respectively,and 95％ CI was 2.316～18.576and 0.058～0.747,respectively.Conclusion The rapid suppression of viral load by nucleotide analogue may improve the efficacy of hepatitis B associated acute on chronic liver failure treatment.The early rapid virological response within first 4 weeks may contribute to the prediction of the treatment outcomes.