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目的回顾分析乙型慢加亚急性肝衰竭患者应用恩替卡韦抗病毒治疗96周的疗效。方法收集40例乙型慢加亚急性肝衰竭患者的基线临床资料与0、4、12、24、48、72、96周的临床检测指标的变化。结果恩替卡韦用药4、12、24、48、72、96周时HBV DNA在检测阴性的比率为32.5%、80.0%、90.0%、95.0%、100.0%、100.0%。e抗原阴转率于24、48、72、96周分别为18.7%、31.2%、43.7%、43.75%,e抗原血清学转换率于48、72、96周分别为12.5%、12.5%、18.7%。ALT、AST、TBiL、ALB、PTA(凝血酶原活动度)复常率96周时分别为100.0%、85.0%、27.5%、100.0%、92.5%。96周时从C级变为A级、B级比例(%):低病毒载量组相对Child-pugh评分改善明显,两者有统计学意义。96周时合并症的有效控制率分别为:上消化道出血88.0%,自发性细菌性腹膜炎(SBP)100.0%,肝性脑病80.0%。应用恩替卡韦安全性良好,无明显不良反应发生。结论恩替卡韦治疗乙肝肝衰竭患者能迅速地抑制HBV DNA复制,而且因为无耐药的发生,改善肝功能的同时,有效地控制了肝硬化合并症,并且药物安全性得到验证,值得推广。
Objective To retrospectively analyze the curative effect of entecavir antiviral therapy for 96 weeks in patients with type B subacute hepatic failure. Methods The baseline clinical data of 40 patients with subfamily B and subacute hepatic failure were collected and the changes of clinical detection indexes at 0, 4, 12, 24, 48, 72 and 96 weeks were collected. Results The rates of negative HBV DNA were 32.5%, 80.0%, 90.0%, 95.0%, 100.0% and 100.0% at 4, 12, 24, 48, 72 and 96 weeks after entecavir administration. The e antigen seroconversion rates were 18.7%, 31.2%, 43.7% and 43.75% at 24, 48, 72 and 96 weeks respectively. The seroconversion rates of e antigen were 12.5%, 12.5% and 18.7 %. The normalization rates of ALT, AST, TBiL, ALB and PTA (prothrombin activity) were 100.0%, 85.0%, 27.5%, 100.0% and 92.5% at 96 weeks respectively. From week C to stage A at week 96, level B (%) showed a significant improvement over Child-pugh score in the low viral load group, both of which were statistically significant. Effective control rates of complications at week 96 were 88.0% of upper gastrointestinal bleeding, 100.0% of spontaneous bacterial peritonitis (SBP) and 80.0% of hepatic encephalopathy. Application of entecavir good safety, no significant adverse reactions. Conclusion Entecavir treatment of hepatitis B patients with liver failure can rapidly inhibit HBV DNA replication, and because of the occurrence of non-resistance, improve liver function, effectively control the complications of cirrhosis, and drug safety has been verified, it is worth promoting.