抗病毒治疗对失代偿期乙型肝炎肝硬化患者经颈静脉肝内门体分流术预后的影响

林静; 魏波; 吴浩; 童欢; 唐承薇

doi:10.3969/j.issn.1001-5256.2016.02.011

抗病毒治疗对失代偿期乙型肝炎肝硬化患者经颈静脉肝内门体分流术预后的影响

DOI: 10.3969/j.issn.1001-5256.2016.02.011

四川大学华西医院消化内科

基金项目:

国家自然科学基金资助项目(NSFC81170413)；

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 2152
- HTML全文浏览量: 41
- PDF下载量: 456
- 被引次数: 0
出版历程
- 收稿日期: 2015-12-18
- 出版日期: 2016-02-20

Effect of antiviral therapy on prognosis of patients with decompensated hepatitis B cirrhosis undergoing transjugular intrahepatic portosystemic shunt

Department of Gastroenterology,West China Hospital,Sichuan University

Research funding:

摘要

摘要:
目的探讨抗病毒治疗对失代偿期乙型肝炎肝硬化患者经颈静脉肝内门体静脉分流术（TIPS）预后的影响。方法回顾性分析2008年1月-2011年12月行TIPS预防静脉曲张破裂再出血的失代偿期乙型肝炎肝硬化患者110例,按其是否使用抗病毒药物,分为TIPS联合抗病毒组（58例）与TIPS组（52例）,计量资料组间比较采用t检验或Wilcoxon秩和检验,计数资料组间比较采用χ2检验,累积生存率、再出血率、支架通畅率和肝细胞癌发生率采用Kaplan-Meier生存分析及log-rank检验。结果 TIPS联合抗病毒组和TIPS组患者TIPS术后1、3和5年累积生存率分别为93.1%、86.1%、77.7%和88.5%、64.9%、59.7%,TIPS联合抗病毒组的累积生存率显著优于TIPS组（χ2=6.833,P=0.009）。TIPS联合抗病毒组的病毒学应答率随着抗病毒治疗时间的延长而逐渐升高。两组累积静脉曲张再出血率、支架通畅率、肝细胞癌发生率的差异均无统计学意义（P值均>0.05）。结论抗病毒治疗可改善失代偿期乙型肝炎肝硬化TIPS术后患者的生存率。
- 肝硬化 /
- 肝炎,乙型 /
- 抗病毒药 /
- 门体分流术,经颈静脉肝内 /
- 预后
Abstract:
Objective To investigate the effect of antiviral therapy on the prognosis of patients with decompensated hepatitis B cirrhosis who underwent transjugular intrahepatic portosystemic shunt( TIPS). Methods The clinical data of 110 patients with decompensated hepatitis B cirrhosis who underwent TIPS to prevent variceal rebleeding from January 2008 to December 2011 were analyzed retrospectively,and based on whether they used antiviral drugs or not,these patients were divided into TIPS- antiviral drug group( 58 patients) and TIPS group( 52patients). The t- test or Wilcoxon rank sum test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. The Kaplan- Meier survival analysis and log- rank test were performed to analyze the cumulative survival rate,rebleeding rate,stent patency rate,and incidence of hepatocellular carcinoma( HCC). Results The 1-,3-,and 5- year cumulative survival rates after TIPS in the TIPS- antiviral drug group versus the TIPS group were 93. 1%vs 88. 5%,86. 1% vs 64. 9%,and 77. 7% vs 59. 7%,respectively,and the TIPS- antiviral drug group had a significantly higher cumulative survival rate than the TIPS group( χ2= 6. 833,P = 0. 009). In the TIPS- antiviral drug group,the virologic response rate increased with the prolonged time of antiviral therapy. The cumulative variceal rebleeding rate,stent patency rate,and incidence of HCC showed no significant differences between the two groups( all P > 0. 05). Conclusion Antiviral therapy can improve the survival rate of patients with decompensated hepatitis B cirrhosis after TIPS.
- liver cirrhosis /
- hepatitis B /
- antiviral agents /
- portosystemic shunt,transjugular intrahepatic /
- prognosis

HTML全文

参考文献(20)

[1]PARKER R.Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension[J].Clin Liver Dis,2014,18(2):319-334.

[2]SAAD WE.Transjugular intrahepatic portosystemic shunt before and after liver transplantation[J].Semin Intervent Radiol,2014,31(3):243-247.

[3] Chinese Society of Hepatology and Chinese Society of Infectious Disease,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].J Clin Hepatol,2010,27(1):Ⅰ-ⅩⅥ.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2010,27(1):Ⅰ-ⅩⅥ.

[4]TERRAULT NA,BZOWEJ NH,CHANG KM,et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology,2016,63(1):261-283.

[5]LIAW YF,KAO JH,PIRATVISUTH T,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2012 update[J].Hepatol Int,2012,6(3):531-561.

[6]European Association for the Study of the Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatol,2012,57(1):167-185.

[7]CHEN S,LI X,WEI B,et al.Recurrent variceal bleeding and shunt patency:prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization[J].Radiology,2013,268(3):900-906.

[8]de FRANCHIS R.Revising consensus in portal hypertension:report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension[J].J Hepatol,2010,53(4):762-768.

[9]Ministry of Health of the People’s Republic of China.Diagnosis,management,and treatment of hepatocellular carcinoma(V2011)[J].J Clin Hepatol,2011,27(11):1141-1158.(in Chinese)中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肝胆病杂志,2011,27(11):1141-1158.

[10]FATTOVICH G,BROLLO L,GIUSTINA G,et al.Natural history and prognostic factors for chronic hepatitis type B[J].Gut,1991,32(3):294-298.

[11]de JONGH FE,JANSSEN HL,de MAN RA,et al.Survival and prognostic indicators in hepatitis B surface antigen-positive cirrhosis of the liver[J].Gastroenterology,1992,103(5):1630-1635.

[12]YAO FY,TERRAULT NA,FREISE C,et al.Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation:a comparative study using a matched,untreated cohort[J].Hepatology,2001,34(2):411-416.

[13]FONTANA RJ,KEEFFE EB,CAREY W,et al.Effect of lamivudine treatment on survival of 309 North American patients awaiting liver transplantation for chronic hepatitis B[J].Liver Transpl,2002,8(5):433-439.

[14]MANOLAKOPOULOS S,KARATAPANIS S,ELEFSINIOTIS J,et al.Clinical course of lamivudine monotherapy in patients with decompensated cirrhosis due to HBeA g negative chronic HBV infection[J].Am J Gastroenterol,2004,99(1):57-63.

[15]JANG JW,CHOI JY,KIM YS,et al.Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus-related cirrhosis[J].Hepatology,2015,61(6):1809-1820.

[16]SINGAL AK,FONTANA RJ.Meta-analysis:oral anti-viral agents in adults with decompensated hepatitis B virus cirrhosis[J].Aliment Pharmacol Ther,2012,35(6):674-689.

[17]LOK AS,HEATHCOTE EJ,HOOFNAGLE JH.Management of hepatitis B:2000-summary of a workshop[J].Gastroenterology,2001,120(7):1828-1853.

[18]ILOEJE UH,YANG HI,SU J,et al.Predicting cirrhosis risk based on the level of circulating hepatitis B viral load[J].Gastroenterology,2006,130(3):678-686.

[19]KIM JD,CHOI JY,BAE SH,et al.Hepatitis B virus load in serum does not reflect histologic activity in patients with decompensated cirrhosis[J].Clin Gastroenterol Hepatol,2010,8(1):60-65.

[20]SIGAL SH,ALA A,IVANOV K,et al.Histopathology and clinical correlates of end-stage hepatitis B cirrhosis:a possible mechanism to explain the response to antiviral therapy[J].Liver Transpl,2005,11(1):82-88.

施引文献

资源附件(0)

访问统计