前列地尔联合恩替卡韦治疗合并腹水的乙型肝炎肝衰竭效果观察

姬会春; 张振江; 朱芳; 刘军权; 刘庆德; 庞伟

doi:10.3969/j.issn.1001-5256.2016.11.030

前列地尔联合恩替卡韦治疗合并腹水的乙型肝炎肝衰竭效果观察

DOI: 10.3969/j.issn.1001-5256.2016.11.030

1. 宿迁市第一人民医院感染科
2. 中国人民解放军第九七医院感染科

基金项目:

南京军区医学科技创新课题经费资助项目(13MA039)；

详细信息

中图分类号: R512.62;R575.3
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出版历程
- 出版日期: 2016-11-20

Clinical effect of alprostadil combined with entecavir in treatment of HBV-related liver failure complicated by ascites

Research funding:

摘要

摘要:
目的观察前列地尔联合恩替卡韦治疗乙型肝炎肝衰竭合并腹水患者的临床效果。方法选取2011年9月-2014年6月于中国人民解放军九七医院住院治疗的乙型肝炎肝衰竭合并腹水患者84例,随机分为治疗组（n=42）和对照组（n=42）。两组患者均予保肝、退黄、利尿、白蛋白营养支持等常规治疗,对照组加用恩替卡韦,治疗组加用前列地尔和恩替卡韦联合治疗。观察记录患者治疗前后的肝功能指标（TBil、ALT、AST）、PTA、HBV DNA载量、临床疗效及24 h尿量和腹水消退情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 2组内治疗前后肝功能指标（TBil、ALT、AST）、PTA、HBV DNA水平比较差异均有统计学意义（P值均<0.05）;治疗组与对照组间治疗后TBil、ALT、AST、PTA比较差异均有统计学意义[TBil:（197.4±47.6）μmol/L vs（287.5±150.6）μmol/L,t=2.30,P<0.05;ALT:（189.4±63.8）U/L vs（263.4±79.5）U/L,t=2.73,P<0.05;AST:（138.7±87...
- 肝功能衰竭 /
- 腹水 /
- 前列地尔 /
- 恩替卡韦 /
- 治疗结果
Abstract:
Objective To investigate the clinical effect of alprostadil combined with entecavir in the treatment of HBV- related liver failure complicated by ascites. Methods A total of 84 patients with HBV- related liver failure complicated by ascites who were hospitalized and treated in No. 97 Hospital of PLA from September 2011 to June 2014 were enrolled and randomly divided into treatment group( 42 patients)and control group( 42 patients). The patients in both groups were given conventional treatment for liver protection,jaundice clearance,diuresis,and albumin nutritional support. The patients in the control group were given entecavir in addition,while those in the treatment group were given alprostadil combined with entecavir in addition. The liver function parameters [total bilirubin( TBil),alanine aminotransferase( ALT),and aspartate aminotransferase( AST) ],prothrombin activity( PTA),HBV DNA load,clinical outcome,24- hour urine volume,and ascites regression before and after treatment were observed and recorded. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Both groups had significant changes in the liver function parameters( TBil,ALT,and AST),PTA,and HBV DNA load after treatment( all P < 0. 05). There were significant differences in TBil,ALT,AST,and PTA after treatment between the treatment group and the control group( TBil: 197. 4 ± 47. 6 μmol / L vs287. 5 ± 150. 6 μmol / L,t = 2. 30,P < 0. 05; ALT: 189. 4 ± 63. 8 U / L vs 263. 4 ± 79. 5 U / L,t = 2. 73,P < 0. 05; AST: 138. 7 ± 87. 5 U / L vs 250. 8 ± 90. 4 U / L,t = 3. 43,P < 0. 05; PTA: 63. 5% ± 17. 0% vs 45. 5% ± 15. 1%,t = 2. 60,P < 0. 05). The treatment group had significantly higher marked response rate and overall response rate concerning clinical outcome than the control group( marked response rate:40. 48% vs 28. 57%,χ2= 4. 32,P < 0. 05; overall response rate: 85. 71% vs 66. 67%,χ2= 4. 20,P < 0. 05). The treatment group also had significantly higher marked response rate and overall response rate concerning ascites regression than the control group( marked response rate: 47. 62% vs 23. 81%,χ2= 13. 20,P < 0. 05; overall response rate: 88. 10% vs 52. 38%,χ2= 12. 81,P < 0. 05). Conclusion In patients with severe hepatitis B complicated by ascites,alprostadil combined with entecavir has good clinical effect and safety and can effectively improve the prognosis. Therefore,it holds promise for clinical application.
- liver failure /
- ascites /
- alprostadil /
- entecatvir /
- treatment outcome

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参考文献(19)

[1] Chinese Society of Hepatology,Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].J Clin Hepatol,2011,27(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,2011,27(1):Ⅰ-ⅩⅥ.

[2]WONG VW,CHAN HL.Severe acute exacerbation of chronic hepatitis B:a unique presentation of a common disease[J].J Gastroenterol Hepatol,2009,24(7):1179-1186.

[3]HUANG K,HU JH,WANG HF,et aI.Survival and prognostic factors in hepatitis B virus-related acute-on-chronic Iiver failure[J].World J Gastroenterol,2011,17(29):3448-3452.

[4]Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association.Diagnostic and treatment guidelines for liver failure[J].Chin J Hepatol,2006,14(9):643-646.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组和肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂志,2006,14(9):643-646.

[5]SHI HD.Clinical observation of alprostadil injection in the treatment of liver cirrbosis with jaundice[J].J Clin Hepatol,2011,27(9):962-964.(in Chinese)施海东.前列地尔注射液治疗肝硬化腹水伴黄疸的临床疗效观察[J].临床肝胆病杂志,2011,27(9):962-964.

[6]INOUE J.Factors involved in the development of fulminant hepatitis B are the mutations of hepatitis B virus implicated[J].J Hepatol,2009,39(11):1053-1055.

[7]LUO GC,HUANG YL,YAN HP,et al.Research on the relationship between serum cytokine levels and prognosis in patients with HBV-related acute-on-chronic liver failure[J].Lab Med,2014,29(1):26-30.(in Chinese)罗光成,黄云丽,闫惠平,等.HBV相关慢加急性肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29(1):26-30.

[8]MAO WL,CHEN Y,CHEN YM,et al.Changes of serum cytokine levels in patients with acute on chronic liver failure treated by plasma exchange[J].J Clin Gastroenterol,2011,45(6):551-555.

[9]FINKENSTEDT A,NACHBAUR K,ZOLLER H,et al.Acute-on-chronic liver failure:excellent outcomes after liver transplantation but high mortality on the wait list[J].Liver Tanspl,2013,19(8):879-886.

[10]NIE QX.Glucocorticoid therapy to improve hepatic failure status[J].Chin J Hepatol,2012,20(6):414-415.(in Chinese)聂和青.糖皮质激素在肝衰竭治疗中的地位[J].中华肝脏病学杂志,2012,20(6):414-415.

[11]SARIN SK,KUMAR A,AMEIDA JA,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the Study of the(APASL)[J].Hepatol Int,2009,3(1):269-282.

[12] LI QF,LIU YN,YANG HL,et al.Effects of adefovir combined with lamivudine on HBV DNA duplication and T cell subsets in chronic hepatitis B patients[J].Int J Virol,2014,21(4):168-171.(in Chinese)黎秋芬,刘亚南,杨红丽,等.阿德福韦酯联合拉米夫定对CHB患者HBV DNA复制和T细胞亚群的影响[J].国际病毒学杂志,2014,21(4):168-171.

[13]GAO HB,XU M,SHI HY,et al.Clinical analysis of antiviral treatment in chronic severe hepatitis B with HBV-DNA positive[J].Chin J Integr Tradit West Med Liver Dis,2011,21(6):330-332.(in Chinese)高洪波,许敏,施海燕,等.HBV-DNA阳性慢性重型乙型肝炎的抗病毒疗效分析[J].中西医结合肝病杂志,2011,21(6):330-332.

[14]SONG MN,MIN F.Lamivudine treatment liver failure with 8-year follow-up[J].J Pract Hepatol,2009,12(6):427-429.(in Chinese)宋闽宁,闵峰.拉米夫定治疗肝衰竭8年随访[J].实用肝脏病杂志,2009,12(6):427-429.

[15]YANG S,WANG H,XU QS,et al.A ranging clincal study of the antiviral treatment with entecavir in the chronic severe hepatitis B patients[J].China Foreign Med Treatment,2011,30(22):1-4.(in Chinese)杨澍,王洪,徐强胜,等.恩替卡韦对慢性乙型重型肝炎抢救作用[J].中外医疗,2011,30(22):1-4.

[16]QIU XW.Clinical effect of alprostadil in treatment of severe hepatitis complicated by hepatorenal syndrome[J].Guide China Med,2013,11(2):513-514.(in Chinese)邱喜文.前列地尔用于重型肝炎合并肝肾综合征的疗效分析[J].中国医药指南,2013,11(2):513-514.

[17]FANG W,LI H,ZHOU L,et al.Effect of prostaglandin E1on TNF-induced vascular inflammation in human umbilicam vein endothelial cells[J].Can J Pharrnacol pharmacol,2010,88(5):576-583.

[18]CAI YK.Clinical effect of alprostadil lipid microsphere combined with furosemide in treatment of intractable ascites[J].J Clin Res,2008,25(4):735-736.(in Chinese)蔡一匡.前列地尔脂徼球配合呋噻米治疗难治性腹水的疗效观察[J].医学临床研究,2008,25(4):735-736.

[19]LI Q,ZHU P.Clinical observation of severe chronic hepatitis treated with alprostadil injection[J].China Med Herald,2012,9(6):73-74.(in Chinese)李群,朱平.前列地尔注射液治疗慢性重型肝炎的临床观察[J].中国医药导报,2012,9(6):73-74.

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