摘要
目的:探讨终末期肝病模型(MELD)在乙型肝炎慢加急性肝功能衰竭患者预后评估意义及恩替卡韦抗病毒治疗短期疗效.方法:84例治疗组乙型病毒性肝炎慢加急性肝功能衰竭患者在常规内科治疗基础上加用恩替卡韦0.5mg/d治疗,99例对照组患者采用常规内科治疗,计算患者入院时的MELD分值和接受治疗2wk后的MELD分值与入院时MELD分值的差值(ΔMELD分值),分析MELD分值和ΔMELD分值与患者6mo病死率的关系.观察不同MELD分值组中恩替卡韦抗病毒治疗对生存率的影响.结果:抗病毒治疗组患者入院时MELD分值和接受治疗2wk后ΔMELD分值预测慢性重型肝炎患者6mo内病死率的C一统计值分别为0.649和0.745.MELD≤25组,治疗组病死率为28.2%(11/39),低于对照组57.9%(22/38),差异有统计学意义(χ2=6.928,P=0.008).25<MELD≤30组,治疗组及对照组病死率分别为42.4%(14/33)、61.7%(29/47),差异无统计学意义(χ2=2.898,P=0.089),30<MELD≤35组,治疗组及对照组病死率分别为62.5%(5/8)、76.9%(10/13),差异无统计学意义(χ2=0.505,P=0.477),MELD>35时,治疗组4例患者2例死亡(2/4),对照组1例患者死亡(1/1),差异无统计学意义(χ2=0.833,P=0.600).结论:MELD可应用于预测乙型肝炎慢加急性肝功能衰竭患者的预后,但接受治疗2wk后的ΔMELD预测能力优于MELD.恩替卡韦抗病毒治疗能提高患者的生存率,但应尽早采用.
AIM：To evaluate the efficacy of enticavir treatment and the model for end-stage liver disease（MELD） as prognostic predictor for the acute-on-chronic hepatitis B liver failure.METHODS：Eighty-four patients with acute-on-chronic hepatitis B liver failure were treated with entecavir 0.5 mg daily and the routine treatment.As a control group,another 99 patients with acute-on-chronic hepatitis B liver failure were treated with the routine treatment for comparison.The MELD scores on the day of their admittance to our hospital and the MELD scores after 2 weeks of medical treatment were retrospectively analyzed.The mortalities of different MELD score groups were also compared between the treatment group and the control group.Analysis was conducted using two-sample t test,the χ2 test and the receiver operating characteristic（ROC） curve where appropriate.RESULTS：The area under the ROC curve of MELD score（c-statistic） was 0.649,while the C-statistic for MELD score was 0.745.On the first day of their admission,when the MELD score was 25,the mortality rates in treatment group and control group were 28.2%（11/39） and 57.9%（22/38）,respectively（χ2=6.928,P=0.008）.When it was 25≤ MELD score 30,the mortality rates in treatment group and control group were 42.4%（14/33） and 61.7%（29/47）,respectively（χ2=2.898,P=0.089）.When it was 30MELD score 35,the mortality rates in treatment group and control group were 62.5%（5/8） and 76.9%（10/13）,respectively（χ2=0.505,P=0.477）.If MELD score 35,the mortality rates in treatment group and control group were 50%（2/4） and 100%（1/1）,respectively（χ2=0.833,P=0.600）.CONCLUSION：The MELD was prognostic indicators in patients with acute on chronic hepatitis B liver failure with entecavir treatment.The MELD was better than MELD to be the prognostic predictor.It suggests that entecavir may prevent fatality in patients with acute-on-chronic hepatitis B liver failure if therapy starts early enough when the MELD score is less than 25.
出处
《第四军医大学学报》
北大核心
2009年第24期3072-3075,共4页
Journal of the Fourth Military Medical University
基金
广东省科技项目(2008B030301052)
关键词
肝炎
乙型
慢性
肝功能衰竭
慢加急性
恩替卡韦
抗病毒治疗
终末期肝病模型
hepatitis B
chronic
liver failure
acute on chronic
entecavir
antiviral therapy
model for end-stage liver disease
