摘要
目的比较慢性乙型病毒性肝炎(慢乙肝)慢加急性肝衰竭(CHB-ACLF)患者中拉米夫定与恩替卡韦抗病毒治疗的短期病死率。方法收集2010年8月至2016年8月在复旦大学附属华山医院感染科住院,使用拉米夫定或恩替卡韦抗乙肝病毒治疗,且出院诊断为CHB-ACLF患者的临床资料。结果共有56例患者纳入研究,拉米夫定组36例,恩替卡韦组20例。拉米夫定组患者7、14和28 d生存率分别为94%、72%和64%,恩替卡韦组患者分别为70%、65%和65%。拉米夫定组7 d病死率低于恩替卡韦组,差异有统计学意义。两组14 d和28 d的病死率差异无统计学意义。亚组分析,终末期肝病模型(MELD)评分≤30分和ACLF 0-1级患者两组28 d生存率差异无统计学意义。有肝硬化基础的患者,拉米夫定组7 d的病死率低于恩替卡韦组,差异有统计学意义,但是两组14 d和28 d的病死率差异无统计学意义。结论 CHB-ACLF患者使用拉米夫定治疗的第1周生存率高于恩替卡韦,但短期(28 d内)生存率与恩替卡韦相似,有肝硬化基础或有肝移植意愿的患者也可考虑拉米夫定治疗。
Objective To compare the short-term mortality of acute-on-chronic liver failure(ACLF)in patients with chronic hepatitis B following lamivudine versus entecavir antiviral treatment.Methods All chronic hepatitis B patients associated with ACLF were included in this analysis if they were treated with lamivudine or entecavirat the Department of Infectious Diseases,Huashan Hospital,Fudan University,from August 2010 to August 2016.Results A total of 56 patients were included(36 in lamivudine group and 20 in entecavir group).The 7-day,14-day and 28-day survival rate was 94%,72%and 64%in lamivudine group,and 70%,65%and 65%in entecavir group.Lamivudine group showed significantly lower 7-day mortality than entecavir group,but no significant difference in 14-day and 28-day mortality.Subgroup analysis did not show significant difference in 28-day mortality between the two groups either in model for end-stage liver disease(MELD)≤30 patients or in ACLF grade 0-1 patients.Lamivudine treatment was associated with significantly lower 7-day mortality than entecavir in cirrhosis patients,but no significant difference in 14-day and 28-day mortality.Conclusions Lamivudine treatment is associated with significantly higher 7-day survival rate than entecavir.However,the short-term(within 28 days)mortality of acute on chronic liver failure in chronic hepatitis B patients is similar between lamivudine and entecavir treatment.Lamivudine is also appropriate for the patients with cirrhosis or waiting for liver transplantation.
作者
郑建铭
黄翀
鱼康康
李宁
ZHENG Jianming;HUANG Chong;YU Kangkang;LI Ning(Department of Infectious Diseases,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2018年第2期132-136,共5页
Chinese Journal of Infection and Chemotherapy
基金
国家十二五重大科技专项(2012ZX10002003
2013ZX10002004)
国家自然科学基金(81371821
81101240)
