Impact of early virological response to antiviral treatment on the outcomes of hepatitis B-associated liver failure
-
摘要:
目的研究在HBV感染相关肝衰竭抗病毒治疗过程中,早期快速病毒学应答对治疗转归的影响。方法选择本院2007年6月至2010年12月住院治疗的HBV感染相关肝衰竭患者152例,在内科综合治疗基础上分别予拉米夫定(LAM)或恩替卡韦(ETV)抗病毒治疗。根据抗病毒治疗第4周时患者HBV DNA是否转阴,将患者分为HBV DNA阴性组和HBV DNA阳性组,比较两组治疗基线情况、治疗第4周时TBil、凝血酶原活动度(PTA)、Alb、MELD评分及治疗终点时两组临床转归,对影响治疗转归的所有因素进行多元Logistic逐步回归分析。结果在治疗第4周时,HBV DNA阴性组TBil水平较HBV DNA阳性组明显降低,两组差异有统计学意义(P=0.000);HBV DNA阴性组PTA较HBV DNA阳性组明显升高,差异有统计学意义(P=0.0001);两组Alb、MELD评分差异无统计学意义。治疗终点时HBV DNA阴性组好转率(74.2%)较HBV DNA阳性组(30.5%)明显升高,差异有统计学意义(χ2=28.15,P=0.0067)。对可能影响治疗转归的因素进行多元Logistic回归分析...
Abstract:Objective To investigate the impact of early virological response to antiviral treatment on the outcomes of hepatitis B-associated liver failure.Methods One-hundred-and-fifty-two patients with hepatitis B-associated liver failure treated in our hospital from June 2007 to December 2010 were retrospectively enrolled in the study.In addition to standard traditional Chinese medicine therapy (including conventional Hugan soup, JiangMei hepatoprotective treatment, and artificial liver treatment) , all patients were given lamivudine (100 mg/d) or entecavir (0.5 mg/d) .The patients were divided into two groups according to hepatitis B virus (HBV) DNA-negative status (indicating early virological response to treatment) and HBV DNA-positive status at week 4.The levels of total bilirubin (TBil) , prothrombin activity (PTA) , and albumin (Alb) , and the MELD score were determined and compared between the two groups.Treatment outcomes were compared at the end of therapy.The factors that impact on the treatment outcomes were determined by stepwise multivariate logistic regression analysis.Results The patients in the HBV DNA-negative group had significantly lower TBil (P=0.000) but significantly higher PTA (P=0.000) at week 4 of treatment than those in the HBV DNA-positive group.There was no significant difference between the two groups for the Alb level or MELD score.The effective rate of therapy was significantly higher in the HBV DNA-negative group than in the HBV DNA-positive group (74.2% vs 30.5%;χ2=28.15, P=0.0067) .The disease stage and early virological response (occurrence of undetectable HBV DNA at week 4 of treatment) were identified as independent factors impacting treatment outcome.Conclusion The ability for a patient to achieve an early virological response (suppression of viral load) to nucleotide analogue treatment may be an indicator of good prognosis for hepatitis B-associated liver failure.
-
Key words:
- hepatitis B virus /
- liver failure
-
[1]Kawakami M, Koda M, Murawaki Y.Cerebral pulsatility in-dex by transcranial Doppler sonography predicts the progno-sis of patients with fulminant hepatic failure[J].Clin Ima-ging, 2010, 34 (5) :327-331. [2]Cakir B, Kirbas I, Demirhan B, et al.Fulminant hepatic fail-ure in children:etiology, histopathology and MDCT findings[J].Eur J Radiol, 2009, 72 (2) :327-334. [3] 叶一农, 高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].中华肝脏病杂志, 2009, 17 (5) :638-640. [4]Davis GL, Hoofnagle JH, Waggoner JG.Spontaneous reacti-vation of chronic hepatitis B virus infection[J].Gastroenter-ology, 1984, 86 (2) :230-235. [5]Dai CY, Yeh ML, Huang CF, et al.Outcome of patients suf-fering from a spontaneous reactivation of hepatitis B presen-ting as acute-on-chronic liver failure and treated with anti-virals[J].Hepatology, 2011, 54 (3) :1108-1109. [6]Levy P, Marcellin P, Martinot-Peignoux M, et al.Clinical course of spontaneous reactivation of hepatitis B virus infec-tion in patients with chronic hepatitis B[J].Hepatology, 1990, 12 (3Pt1) :570-574. [7]Sarin SK, Kumar A, Almeida JA, et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) [J].Hepatol Int, 2009, 3 (1) :269-282. [8]中华医学会感染病学分会肝衰竭与人工肝学组、中华医学会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. [9]李兰娟, 黄建荣, 杨芊.2001年国际人工肝学术会议纪要[J].中华肝脏病杂志, 2001, 9 (6) :383-384. [10]Shaikh T, Cooper C.Reassessing the role for lamivudine in chronic hepatitis B infection:a four-year cohort analysis[J].Can J Gastroenterol, 2012, 26 (3) :148-150. [11]赵振刚, 韩涛, 高英堂, 等.乙型肝炎患者并发慢加急性肝衰竭诱因及转归分析289例[J].世界华人消化杂志, 2009, 17 (31) :3269-3272. [12]Yu JW, Sun LJ, Yan BZ, et al.Lamivudine treatment is as-sociated with improved survival in fulminant hepatitis B[J].Liver Int, 2011, 31 (4) :499-506. [13]肖光明, 贾卫东, 何凯茵, 等.应用COX比例风险模型分析抗病毒治疗对慢性乙型重型肝炎预后的影响[J].实用肝脏病杂志, 2009, 12 (3) :190-192. [14]Yu JW, Sun LJ, Zhao YH, et al.Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment[J].J Gastroen-terol Hepatol, 2008, 23 (8Pt1) :1242-1249. [15]Sanchez MJ, Buti M, Homs M, et al.Successful use of en-tecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab[J].J Hep-atol, 2009, 51 (6) :1091-1096. [16]Chen J, Han JH, Liu C, et al.Short-term entecavir therapy of chronic severe hepatitis B[J].Hepatobiliary Pancreat Dis Int, 2009, 8 (3) :261-266. [17]潘晨, 黄祖雄, 林彩文, 等.恩替卡韦联合血浆置换治疗慢性乙型重型肝炎10例[J].中华传染病杂志, 2008, 26 (10) :623-624. [18]Yu JW, Sun LJ, Zhao YH, et al.The study of efficacy of lamivudine in patients with severe acute hepatitis B[J].Dig Dis Sci, 2010, 55 (3) :775-783. [19]何卫平, 王慧芬.HBV相关肝衰竭抗病毒治疗进展[J].临床肝胆病杂志, 2009, 25 (3) :77-79. [20]Lok A, McMahon BJ.Chronic hepatitis B:update2009[J].Hepatology, 2009, 50 (3) :661-662. [21] 胡瑾华, 王慧芬, 何卫平, 等.核苷类似物治疗早中期HBV-ACLF患者随机对照临床研究[J].中华实验和临床病毒学杂志, 2010, 24 (3) :205-208. [22]Lange CM, Bojunga J, Hofmann WP, et al.Severe lactic ac-idosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function[J].Hepatology, 2009, 50 (6) :2001-2006.
计量
- 文章访问数: 3126
- HTML全文浏览量: 18
- PDF下载量: 692
- 被引次数: 0