CAJ | 학술논문

目的：探讨恩替卡韦治疗慢加亚急性乙型肝炎肝衰竭（HBV-ACLF）患者的疗效。方法选择2003年~2012年在本院住院并应用恩替卡韦抗乙型肝炎病毒治疗的HBV-ACLF患者37例作为治疗组，同时选择在本院住院未应用任何抗乙型肝炎病毒药物的HBV-ACLF患者37例作为对照组。采用回顾性研究方法比较两组患者临床体征、血生化指标、终末期肝病模型（MELD）评分、累积生存率和2年内复发率情况。结果在入院时、治疗后4w、8w、12w时，治疗组患者外周血谷丙转氨酶（ALT）、谷草转氨酶（AST）、血总胆红素（TBIL）、血肌酐（Cr），凝血酶原活动度（PTA）和MELD评分与对照组相比，差异均无统计学意义（P>0.05）；两组腹水、消化道出血、肝性脑病和肝肾综合征发生率比较,除在治疗4w末时，治疗组生存者腹水发病率为41.4%，低于对照组生存者的66.7%（P<0.05），余无统计学差异（P>0.05）；在治疗8w、12w和24w时，37例抗病毒患者生存率分别为75.7%、75.7%和70.3%，均明显高于对照组的67.6%、56.8%和54.1%（P<0.05）；26例抗病毒的生存患者在2年内病情无复发，而20例未抗病毒的生存患者复发率为65.0%（P<0.001）。结论给予HBV-ACLF患者恩替卡韦抗病毒治疗，可提高生存率，减少病情复发。
목적：탐토은체잡위치료만가아급성을형간염간쇠갈（HBV-ACLF）환자적료효。방법선택2003년~2012년재본원주원병응용은체잡위항을형간염병독치료적HBV-ACLF환자37례작위치료조，동시선택재본원주원미응용임하항을형간염병독약물적HBV-ACLF환자37례작위대조조。채용회고성연구방법비교량조환자림상체정、혈생화지표、종말기간병모형（MELD）평분、루적생존솔화2년내복발솔정황。결과재입원시、치료후4w、8w、12w시，치료조환자외주혈곡병전안매（ALT）、곡초전안매（AST）、혈총담홍소（TBIL）、혈기항（Cr），응혈매원활동도（PTA）화MELD평분여대조조상비，차이균무통계학의의（P>0.05）；량조복수、소화도출혈、간성뇌병화간신종합정발생솔비교,제재치료4w말시，치료조생존자복수발병솔위41.4%，저우대조조생존자적66.7%（P<0.05），여무통계학차이（P>0.05）；재치료8w、12w화24w시，37례항병독환자생존솔분별위75.7%、75.7%화70.3%，균명현고우대조조적67.6%、56.8%화54.1%（P<0.05）；26례항병독적생존환자재2년내병정무복발，이20례미항병독적생존환자복발솔위65.0%（P<0.001）。결론급여HBV-ACLF환자은체잡위항병독치료，가제고생존솔，감소병정복발。
Objective To investigate the efficacy of entecavir in treatment of patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF). Methods 74 patients with HBV-ACLF were enrolled in Third People’s Hospital,Nantong,from 2003 to 2012. Among them,37 patients were given entecavir while receiving liver-protecting treatment,and the other 37 cases were given only basic protecting treatment without any antiviral medication as control group. The clinical characteristic at administration,the results of liver function such as alanine transaminase (ALT),aspartate transaminase(AST),albumin (ALB),creatine(Cr),prothrombin time (PT) , the score of model for end-stage liver disease (MELD),cumulative survival rates and recurrence rates within 24 months were compared between the two groups by means of t-test and Chi-Square test. Results The serum levels of ALT,AST,ALB,Cr,plasma prothrombin activity (PTA) and MELD scores between the two groups had no statistical differences after 4-week,8-week and 12 week treatment;The morbidity of ascites,gastrointestinal bleeding,encephalopathy,and hepatorenal syndrome between the two groups had no statistical differences except the morbidity of ascites in the survivors of the entecavir group was 41.4%,lowwer than 66.7%(P<0.05) in the control group at the end of the fourth week;The survival rates in 37 patients receiving antiviral therapy at 8w, 12w and 24w,were 75.7%,75.7% and 70.3%,much higher than 67.6%,56.8% and 54.1%(P<0.05)in the control;At the end of 2-year observation, there was no recurrence in 26 survivals with entecavir treatment, while the recurrence rate was 65.0%(P<0.001) in 20 patients without antiviral therapy in the control. Conclusion Enticavir treatment may improve the survival of patients with HBV-ACLF with less disease recurrence.