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目的探讨恩替卡韦治疗慢加急性乙型肝炎肝衰竭近期疗效。方法 68例慢加急性乙型肝炎肝衰竭患者被分成治疗组(42例)和对照组(26例),对照组采用常规内科治疗,治疗组在常规内科治疗基础上加用恩替卡韦0.5mg/d,比较两组治疗后血生化指标、凝血酶原活动度、HBV DNA水平、MELD分值变化及病死率。结果在治疗后12周,治疗组总胆红素和HBV DNA分别为89.7±42.5μmol/L和3.16±2.04log10copies/mL,显著低于对照组患者(145.6±64.2μmol/L和6.28±3.95log10copies/mL,P<0.01),凝血酶原活动度和白蛋白分别为48.5±15.6%和34.8±4.8g/L,显著高于对照组(40.5±12.4%和30.2±4.1g/L,P<0.05或P<0.01);治疗组早中期患者MELD分值和病死率分别为17.6±3.5和20.0%,显著低于对照组(22.4±4.1和52.9%,P<0.05或P<0.01),两组晚期患者MELD分值和病死率差异无统计学意义(P>0.05);治疗组有1例HBeAg阴转,1例HBeAg血清学转换,对照组HBVM无变化。结论恩替卡韦能有效抑制HBV复制,改善慢加急性乙型肝炎肝衰竭患者肝功能,降低早中期患者MELD分值和病死率。尽早抗病毒治疗可提高慢加急性乙型肝炎肝衰竭患者的生存率。
Objective To investigate the short-term curative effect of entecavir in treating chronic liver failure with acute and chronic hepatitis B. Methods Sixty-eight patients with chronic hepatitis B and chronic hepatitis B were divided into treatment group (n = 42) and control group (n = 26). The control group received conventional medical treatment. The treatment group was given entecavir 0.5 mg / d The blood biochemical parameters, prothrombin activity, HBV DNA level, MELD scores and mortality were compared between the two groups. Results At 12 weeks after treatment, total bilirubin and HBV DNA in the treatment group were 89.7 ± 42.5μmol / L and 3.16 ± 2.04log10copies / mL, respectively, which were significantly lower than those in the control group (145.6 ± 64.2μmol / L and 6.28 ± 3.95log10copies / mL, P <0.01). Prothrombin activity and albumin were 48.5 ± 15.6% and 34.8 ± 4.8 g / L, respectively, which were significantly higher than those in the control group (40.5 ± 12.4% and 30.2 ± 4.1 g / L, P < 0.05 or P <0.01). The MELD score and case fatality rate were 17.6 ± 3.5 and 20.0% in the early and middle stages of the treatment group, which were significantly lower than those in the control group (22.4 ± 4.1 and 52.9%, P <0.05 or P <0.01) There was no significant difference in MELD score and mortality between the two groups (P> 0.05). In the treatment group, there was one case of HBeAg negative conversion and one case of HBeAg seroconversion, while the control group had no change of HBVM. Conclusion Entecavir can effectively inhibit HBV replication, improve liver function in patients with chronic hepatitis B and chronic hepatitis B, and reduce MELD score and mortality in early and mid-term patients. Antiviral therapy as soon as possible can improve the survival rate of patients with chronic hepatitis B and chronic liver failure.