中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2015年
1期
17-22
,共6页
高海兵%林明华%潘晨%林太杰%王香梅%周锐%李孝楼
高海兵%林明華%潘晨%林太傑%王香梅%週銳%李孝樓
고해병%림명화%반신%림태걸%왕향매%주예%리효루
肝炎病毒,乙型%肝功能衰竭%核苷类药物%生存分析
肝炎病毒,乙型%肝功能衰竭%覈苷類藥物%生存分析
간염병독,을형%간공능쇠갈%핵감류약물%생존분석
Hepatitis B virus%Liver failure%Nucleoside analogues%Survival analysis
目的 探讨不同核苷类似物对HBV相关慢加急性肝衰竭患者的远期生存率的影响.方法 采用前瞻性队列研究,选择HBV相关慢加急性肝衰竭180例患者作为研究对象,按自主选择原则,分为基础治疗组及抗病毒治疗组(包括拉米夫定治疗组、替比夫定治疗组、恩替卡韦治疗组),随访24个月,应用Kaplan-Meier法进行生存分析. 结果 180例患者均完成随访,4组患者基线临床特征差异无统计学意义.治疗1个月时各组生存率比较,差异无统计学意义(Breslow=4.475,P=0.215),但2、3、6、12和18个月时基础治疗组生存率均低于拉米夫定组、替比夫定组及恩替卡韦组,差异有统计学意义(P＜ 0.05);但3组抗病毒组生存率组间比较,差异均无统计学意义(P＞0.05).24个月时,基础治疗组生存率仍低于拉米夫定组、替比夫定组及恩替卡韦组(Breslow 值分别为5.604、5.621、14.701,P值均＜0.05),差异均有统计学意义.24个月时,拉米夫定组与替比夫定组的生存率比较,P＞ 0.05,差异无统计学意义;但这两组生存率均低于恩替卡韦组,Breslow值分别为4.010、4.307,P值均＜0.05,差异均有统计学意义.分层分析发现基线30％＜凝血酶原活动度(PTA)≤40％或MELD评分≤29或HBV DNA≥51og10 IU/ml的患者治疗1个月时,基础治疗组与抗病毒治疗组累积生存率比较,差异无统计学意义(P＞ 0.05);而2、3、6、12、18、24个月时基础治疗组累积生存率则低于抗病毒治疗组(P＜0.05);20％＜PTA≤30％患者随访1个月至24个月基础治疗组累积生存率均低于抗病毒治疗组,P＜ 0.05,差异有统计学意义;而PTA≤20％或MELD≥30％两组患者随访1个月至24个月累积生存率差异均无统计学意义.基线HBV DNA＜5 log10 IU/ml的患者,治疗1、2、3、6、12、18个月时基础治疗组生存率与抗病毒治疗组比较,差异无统计学意义;而24个月生存率低于抗病毒治疗组,差异有统计学意义(B reslow=4.055,P=0.044). 结论 核苷类似物能够提高HBV相关慢加急性肝衰竭患者的长期生存率,恩替卡韦更适合患者的长期治疗.早期、中期及HBV DNA阳性的患者均应尽早进行抗病毒治疗.
目的 探討不同覈苷類似物對HBV相關慢加急性肝衰竭患者的遠期生存率的影響.方法 採用前瞻性隊列研究,選擇HBV相關慢加急性肝衰竭180例患者作為研究對象,按自主選擇原則,分為基礎治療組及抗病毒治療組(包括拉米伕定治療組、替比伕定治療組、恩替卡韋治療組),隨訪24箇月,應用Kaplan-Meier法進行生存分析. 結果 180例患者均完成隨訪,4組患者基線臨床特徵差異無統計學意義.治療1箇月時各組生存率比較,差異無統計學意義(Breslow=4.475,P=0.215),但2、3、6、12和18箇月時基礎治療組生存率均低于拉米伕定組、替比伕定組及恩替卡韋組,差異有統計學意義(P＜ 0.05);但3組抗病毒組生存率組間比較,差異均無統計學意義(P＞0.05).24箇月時,基礎治療組生存率仍低于拉米伕定組、替比伕定組及恩替卡韋組(Breslow 值分彆為5.604、5.621、14.701,P值均＜0.05),差異均有統計學意義.24箇月時,拉米伕定組與替比伕定組的生存率比較,P＞ 0.05,差異無統計學意義;但這兩組生存率均低于恩替卡韋組,Breslow值分彆為4.010、4.307,P值均＜0.05,差異均有統計學意義.分層分析髮現基線30％＜凝血酶原活動度(PTA)≤40％或MELD評分≤29或HBV DNA≥51og10 IU/ml的患者治療1箇月時,基礎治療組與抗病毒治療組纍積生存率比較,差異無統計學意義(P＞ 0.05);而2、3、6、12、18、24箇月時基礎治療組纍積生存率則低于抗病毒治療組(P＜0.05);20％＜PTA≤30％患者隨訪1箇月至24箇月基礎治療組纍積生存率均低于抗病毒治療組,P＜ 0.05,差異有統計學意義;而PTA≤20％或MELD≥30％兩組患者隨訪1箇月至24箇月纍積生存率差異均無統計學意義.基線HBV DNA＜5 log10 IU/ml的患者,治療1、2、3、6、12、18箇月時基礎治療組生存率與抗病毒治療組比較,差異無統計學意義;而24箇月生存率低于抗病毒治療組,差異有統計學意義(B reslow=4.055,P=0.044). 結論 覈苷類似物能夠提高HBV相關慢加急性肝衰竭患者的長期生存率,恩替卡韋更適閤患者的長期治療.早期、中期及HBV DNA暘性的患者均應儘早進行抗病毒治療.
목적 탐토불동핵감유사물대HBV상관만가급성간쇠갈환자적원기생존솔적영향.방법 채용전첨성대렬연구,선택HBV상관만가급성간쇠갈180례환자작위연구대상,안자주선택원칙,분위기출치료조급항병독치료조(포괄랍미부정치료조、체비부정치료조、은체잡위치료조),수방24개월,응용Kaplan-Meier법진행생존분석. 결과 180례환자균완성수방,4조환자기선림상특정차이무통계학의의.치료1개월시각조생존솔비교,차이무통계학의의(Breslow=4.475,P=0.215),단2、3、6、12화18개월시기출치료조생존솔균저우랍미부정조、체비부정조급은체잡위조,차이유통계학의의(P＜ 0.05);단3조항병독조생존솔조간비교,차이균무통계학의의(P＞0.05).24개월시,기출치료조생존솔잉저우랍미부정조、체비부정조급은체잡위조(Breslow 치분별위5.604、5.621、14.701,P치균＜0.05),차이균유통계학의의.24개월시,랍미부정조여체비부정조적생존솔비교,P＞ 0.05,차이무통계학의의;단저량조생존솔균저우은체잡위조,Breslow치분별위4.010、4.307,P치균＜0.05,차이균유통계학의의.분층분석발현기선30％＜응혈매원활동도(PTA)≤40％혹MELD평분≤29혹HBV DNA≥51og10 IU/ml적환자치료1개월시,기출치료조여항병독치료조루적생존솔비교,차이무통계학의의(P＞ 0.05);이2、3、6、12、18、24개월시기출치료조루적생존솔칙저우항병독치료조(P＜0.05);20％＜PTA≤30％환자수방1개월지24개월기출치료조루적생존솔균저우항병독치료조,P＜ 0.05,차이유통계학의의;이PTA≤20％혹MELD≥30％량조환자수방1개월지24개월루적생존솔차이균무통계학의의.기선HBV DNA＜5 log10 IU/ml적환자,치료1、2、3、6、12、18개월시기출치료조생존솔여항병독치료조비교,차이무통계학의의;이24개월생존솔저우항병독치료조,차이유통계학의의(B reslow=4.055,P=0.044). 결론 핵감유사물능구제고HBV상관만가급성간쇠갈환자적장기생존솔,은체잡위경괄합환자적장기치료.조기、중기급HBV DNA양성적환자균응진조진행항병독치료.
Objective To investigate the effect of different nucleoside analogues on the long-term survival rate of patients with acute-on-chronic liver failure (ACLF) associated with hepatitis B virus (HBV) infection.Methods One hundred and eighty patients with HBV-related ACLF were enrolled in this prospective cohort study and divided into a basic trcatmcnt group (n =30) and an antiviral treatment group,the latter of which was further subdivided into the lamivudine treatment group (n =66),telbivudine treatment group (n =38) and entecavir treatment group (n =46) according to voluntary choice by the patient.All study participants were followed-up for 24 months.The Kaplan-Meier method was applied for survival analysis.Results The patients in the four antiviral treatment groups had statistically similar baseline clinical characteristics and 1-month survival rates (Breslow =4.475,P =0.215).However,the basic treatment group had a significantly lower survival rate than the antiviral treatment groups that received lamivudine,telbivudine,or entecavir (all P ＜ 0.05) at the treatment periods of 2,3,6,12 and 18-months; however,these three treatment groups showed no significant differences in survival rates.At the time point of 24 months of treatment,the basic treatment group retained its lower rate of survival than the three antiviral treated groups (lamivudine:Breslow =5.604,P =0.018; telbivudine:Breslow =5.621,P =0.018; entecavir:Breslow =14.701,P ＜ 0.001); while the survival rates were similar for the lamivudine treatment group and the telbivudine treatment group at this time point,their survival rates were significantly lower than that of the entecavir treatment group (Breslow =4.010,P =0.045; Breslow =4.307,P =0.038).Stratification analysis showed that when the baseline was 30 ＜ PTA ≤ 40 or MELD ≤ 29 or HBV DNA ≥ 5 log10 IU/mL,the cumulative survival rates of the basic treatment group and antiviral treatment group were statistically similar even though the patients had completed 1 month of treatment After being treated for 2,3,6,12,18 and 24 months,the cumulative survival rates of the basic treatment group were consistently below those of the overall antiviral treatment group (P ＜ 0.05).The cumulative survival rate of the basic treatment group followed-up for 1 to 24 months,with PTA values between 20 and 30,was lower than that of the overall antiviral treatment group (P ＜ 0.05); two groups of patients with PTA ≤ 20 or MELD ≥ 30 were followed-up for 1 months to 24 months,and their cumulative survival rates showed no significant difference (P ＞ 0.05).Among the patients whose baseline was HBV DNA ＜ 5 log10 IU/mL,the comparison of survival rates between the basic treatment group and the overall antiviral treatment group showed no significant differences after treatment for 1,2,3,6,12 or 18 months,and the survival rate was lower than that of the overall antiviral treatment group (Breslow =4.055,P =0.044) after 24 months.Conclusion Nucleoside analogues can improve the long-term survival rate of HBV-related ACLF patients.Entecavir is preferred for the long-term treatment of these patients.Patients in the early and middle stages of this disease and HBV DNA-positive patients should adopt antiviral treatment as early as possible.
