慢性乙型肝炎慢加急性肝衰竭患者應(yīng)用不同抗病毒藥物治療后的臨床療效觀察
發(fā)布時(shí)間：2018-10-23 11:08
【摘要】：研究目的 觀察拉米夫定（Lamivudin，LAM）、恩替卡韋（Entecavir，ETV）、拉米夫定聯(lián)合阿德福韋酯（Adefovir dipivoxi，ADV）（以下簡稱聯(lián)合）治療慢性乙型肝炎慢加急性肝衰竭（hepatitis B virus related acute-on-chronic liver failure，HBV-ACLF）早、中期患者的24周臨床療效。以期找到更合理、更經(jīng)濟(jì)、更安全有效的抗病毒治療方案，快速控制HBV感染所致慢加急性肝衰竭患者的病情，為后期治療及肝臟細(xì)胞再生贏得時(shí)間，降低肝衰竭患者的死亡率。 研究方法 收集并采用回顧性分析2010年12月至2013年6月期間在我院感染科確診并治療的89例HBV-ACLF早、中期患者的臨床數(shù)據(jù)及隨訪記錄。其中25例患者接受恩替卡韋抗病毒治療，42例患者接受拉米夫定治療，22例患者接受聯(lián)合治療，比較三組患者在治療前后0、4、8、12、24周的臨床生化指標(biāo)改善程度、病毒載量的下降幅度、出現(xiàn)各種并發(fā)癥的幾率以及短期內(nèi)生存率和死亡率等方面綜合判斷三種不同抗病毒方案的優(yōu)劣。 結(jié)果 1.三組患者的人口學(xué)特征及初始治療時(shí)臨床指標(biāo)的比較，差異均無統(tǒng)計(jì)學(xué)意義（P0.05） 2.與本組治療前基線相比較，3組患者24周后ALT均明顯下降，差異有統(tǒng)計(jì)學(xué)意義（P0.001）。 3.與本組治療前基線相比較，3組患者TBil水平在治療第2、4周時(shí)均有所上升，治療4周后開始下降，24周后TBil水平明顯下降，差異有統(tǒng)計(jì)學(xué)意義（P0.001）。 4.與本組治療前基線相比較，3組患者24周后PTA均明顯上升，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 5.與本組治療前基線相比較，3組患者HBV-DNA滴度在治療4周后均快速下降，差異有統(tǒng)計(jì)學(xué)意義（P0.001）。 6.24周后恩替卡韋治療組與聯(lián)合治療組相比，HBV-DNA滴度明顯降低，2組間差異有統(tǒng)計(jì)學(xué)意義（P=0.0022）。 7.比較隨訪結(jié)束時(shí)恩替卡韋治療組HBV-DNA低于檢測下限即轉(zhuǎn)陰率為62.5%，，拉米夫定治療組轉(zhuǎn)陰率為25%，聯(lián)合組轉(zhuǎn)陰率為16.7%，三組轉(zhuǎn)陰率差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。 8.24周后，恩替卡韋治療組死亡9例，死亡率為36%；拉米夫定治療組死亡10例，死亡率為23.8%；聯(lián)合治療組死亡10例，死亡率為45.5%，差異無統(tǒng)計(jì)學(xué)意義,在死亡原因分析中,三組患者死于各類并發(fā)癥的比較,差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 9.隨訪結(jié)束時(shí)恩替卡韋治療組存活16例，存活率為64%，拉米夫定治療組存活32例，存活率為76.2%，聯(lián)合治療組存活12例，存活率為54.5%，三組患者生存曲線比較，差異無統(tǒng)計(jì)學(xué)意義（P0.05），兩兩比較無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論 三種抗病毒方案均能快速下降慢性乙型肝炎慢加急性肝衰竭患者的ALT、TBil以及HBV-DNA等臨床指標(biāo)，促進(jìn)肝功能的恢復(fù)，24周內(nèi)患者的死亡率及累計(jì)存活率在三組之間差別無統(tǒng)計(jì)學(xué)意義，但從長遠(yuǎn)來看，恩替卡韋可能會(huì)達(dá)到更好的病毒學(xué)應(yīng)答。
[Abstract]:Objective to observe the 24 week clinical efficacy of lamivudine (Lamivudin,LAM), entecavir (Entecavir,ETV), lamivudine and adefovir (Adefovir dipivoxi,ADV) in the treatment of chronic hepatitis B (CHB) with acute hepatic failure (hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF). In order to find a more reasonable, more economical, more safe and effective antiviral treatment, to quickly control the condition of patients with chronic and acute liver failure caused by HBV infection, to buy time for later treatment and liver cell regeneration, and to reduce the mortality of patients with liver failure. Methods the clinical data and follow-up records of 89 cases of HBV-ACLF diagnosed and treated in our hospital from December 2010 to June 2013 were collected and analyzed retrospectively. Among them, 25 patients received entecavir antiviral therapy, 42 patients received lamivudine treatment, 22 patients received combined treatment. The improvement degree of clinical biochemical indexes and the decrease of viral load were compared between the three groups before and after treatment. The probability of various complications, short-term survival rate and death rate were used to judge the merits and demerits of three different antiviral protocols. Result 1. The demographic characteristics of the three groups of patients and the initial treatment of clinical indicators, the differences were not statistically significant (P0.05) 2. 5. Compared with baseline before treatment, ALT decreased significantly in the three groups after 24 weeks (P0.001). Compared with the baseline before treatment, the level of TBil in the three groups increased at the 2nd week, began to decrease after 4 weeks of treatment, and decreased significantly after 24 weeks of treatment (P0.001). The difference was statistically significant (P0.001). Compared with the baseline before treatment, the PTA of the 3 groups increased significantly after 24 weeks, the difference was statistically significant (P0.05). Compared with baseline before treatment, the titer of HBV-DNA in the three groups decreased rapidly after 4 weeks of treatment. After 6.24 weeks, the titer of HBV-DNA in the entecavir group was significantly lower than that in the combined treatment group, and the difference between the two groups was statistically significant (P0. 0022). At the end of follow-up, the HBV-DNA of the treatment group was lower than the lower detection limit (62.5%), the negative conversion rate of lamivudine group was 25%, and the negative conversion rate of the combined group was 16.7%. There was significant difference among the three groups after 8. 24 weeks (P < 0. 05). There were 9 deaths in the entecavir group with a mortality rate of 36; 10 deaths in the lamivudine group with a mortality rate of 23.80.The combined treatment group had 10 deaths, with a mortality rate of 45.5. The difference was not statistically significant. Three groups of patients died from various complications, the difference was not statistically significant (P0.05). At the end of follow-up, 16 cases survived in entecavir group (64%), 32 cases survived in lamivudine group (76.2%), 12 cases survived in combination group (54.5%). The difference was not statistically significant (P0.05), pairwise comparison had no statistical significance (P0.05). Conclusion all three antiviral regimens can rapidly decrease the ALT,TBil and HBV-DNA in patients with chronic hepatitis B and acute liver failure. There was no significant difference in mortality and cumulative survival rate between the three groups within 24 weeks, but in the long run, entecavir might achieve a better virological response.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62
本文編號：2289053
[Abstract]:Objective to observe the 24 week clinical efficacy of lamivudine (Lamivudin,LAM), entecavir (Entecavir,ETV), lamivudine and adefovir (Adefovir dipivoxi,ADV) in the treatment of chronic hepatitis B (CHB) with acute hepatic failure (hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF). In order to find a more reasonable, more economical, more safe and effective antiviral treatment, to quickly control the condition of patients with chronic and acute liver failure caused by HBV infection, to buy time for later treatment and liver cell regeneration, and to reduce the mortality of patients with liver failure. Methods the clinical data and follow-up records of 89 cases of HBV-ACLF diagnosed and treated in our hospital from December 2010 to June 2013 were collected and analyzed retrospectively. Among them, 25 patients received entecavir antiviral therapy, 42 patients received lamivudine treatment, 22 patients received combined treatment. The improvement degree of clinical biochemical indexes and the decrease of viral load were compared between the three groups before and after treatment. The probability of various complications, short-term survival rate and death rate were used to judge the merits and demerits of three different antiviral protocols. Result 1. The demographic characteristics of the three groups of patients and the initial treatment of clinical indicators, the differences were not statistically significant (P0.05) 2. 5. Compared with baseline before treatment, ALT decreased significantly in the three groups after 24 weeks (P0.001). Compared with the baseline before treatment, the level of TBil in the three groups increased at the 2nd week, began to decrease after 4 weeks of treatment, and decreased significantly after 24 weeks of treatment (P0.001). The difference was statistically significant (P0.001). Compared with the baseline before treatment, the PTA of the 3 groups increased significantly after 24 weeks, the difference was statistically significant (P0.05). Compared with baseline before treatment, the titer of HBV-DNA in the three groups decreased rapidly after 4 weeks of treatment. After 6.24 weeks, the titer of HBV-DNA in the entecavir group was significantly lower than that in the combined treatment group, and the difference between the two groups was statistically significant (P0. 0022). At the end of follow-up, the HBV-DNA of the treatment group was lower than the lower detection limit (62.5%), the negative conversion rate of lamivudine group was 25%, and the negative conversion rate of the combined group was 16.7%. There was significant difference among the three groups after 8. 24 weeks (P < 0. 05). There were 9 deaths in the entecavir group with a mortality rate of 36; 10 deaths in the lamivudine group with a mortality rate of 23.80.The combined treatment group had 10 deaths, with a mortality rate of 45.5. The difference was not statistically significant. Three groups of patients died from various complications, the difference was not statistically significant (P0.05). At the end of follow-up, 16 cases survived in entecavir group (64%), 32 cases survived in lamivudine group (76.2%), 12 cases survived in combination group (54.5%). The difference was not statistically significant (P0.05), pairwise comparison had no statistical significance (P0.05). Conclusion all three antiviral regimens can rapidly decrease the ALT,TBil and HBV-DNA in patients with chronic hepatitis B and acute liver failure. There was no significant difference in mortality and cumulative survival rate between the three groups within 24 weeks, but in the long run, entecavir might achieve a better virological response.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62
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