拉米夫定、α-干扰素及苦参素治疗存活的乙型肝炎肝衰竭患者

[Lamivudine, interferon-alpha and oxymatrine treatment for the surviving hepatic failure patients with hepatitis B].

作者信息

Chen Cong-xin, Liu Bo, Ma Yong, Zhou Yue-jin, Pan Xing-nan, Zhen Rui-dan, Wang Quan-chu, Wang Mao-rong, He Chang-lun, Fu Qing-chun, Chen Cheng-wei

机构信息

Department of Infectious Diseases, 105th Hospital, Anhui Medical University, Hefei 230031, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2009 Jul;17(7):505-8.

PMID:19912684

Abstract

OBJECTIVE

To investigate the effect of lamivudine, interferon alpha and oxymatrine treatment for surviving hepatic failure patients with hepatitis B.

METHODS

200 hepatitis B patients, including 100 subacute or acute-on-chronic hepatic failure survivals (group A), and 100 chronic (group B, n=100) hepatic failure survivals, were enrolled in this study. Patients in group A received interferon alpha (n=35), lamivudine (n=33) , or combinational lamivudine and oxymatrine (n=32) therapy for six months; Patients in group B received lamivudine (n=49), or combinational lamivudine and oxymatrine (n=51) therapy for six months, respectively. After the treatment, all patients were followed-up for six months.

RESULTS

At the end of follow-up, all patients in group A survived, while in group B three patients (6.1%) receiving lamivudine, and four (7.8%, P>0.05) receiving combinational therapy died; more than 90% of all survivals had their HBV DNA loss. The HBeAg/anti-HBe seroconversion rate in patients of group A treated with interferon alpha (9/17, 52.9%) was higher than that in patients treated with combinational lamivudine and matrine (5/16, 31.3%, P<0.05), which was higher than that in the patients treated with lamivudine alone (1/17, 5.9%, P<0.01), and the Knodell histological activity index score in patients treated with lamivudine (7.2+/-0.8, P<0.05) was lower than that in patients treated with interferon alpha (8.2+/-1.3, P<0.05), and the best efficacy was found in receiving combinational therapy (6.9+/-0.7, P<0.01); Lamivudine or lamivudine in combination with matrine significantly inhibited the intrahepatic inflammatory activities, but had no effect on the existing fibrosis in group B patients.

CONCLUSION

Long term nucleotide analogues treatment may delay the progress of fibrosis in hepatitis B-induced hepatic failure survivals, and the administration of matrine in time may further enhance the anti-fibrotic effect of nucleotide analogues.

摘要

目的

探讨拉米夫定、干扰素α及苦参素治疗乙型肝炎肝衰竭存活患者的效果。

方法

本研究纳入200例乙型肝炎患者，其中100例亚急性或慢性乙型肝炎急性发作肝衰竭存活患者（A组），100例慢性肝衰竭存活患者（B组）。A组患者分别接受干扰素α（n = 35）、拉米夫定（n = 33）或拉米夫定联合苦参素（n = 32）治疗6个月；B组患者分别接受拉米夫定（n = 49）或拉米夫定联合苦参素（n = 51）治疗6个月。治疗后，所有患者均随访6个月。

结果

随访结束时，A组所有患者均存活，而B组中接受拉米夫定治疗的3例患者（6.1%）及接受联合治疗的4例患者（7.8%，P>0.05）死亡；所有存活患者中超过90%的患者乙肝病毒脱氧核糖核酸（HBV DNA）转阴。A组接受干扰素α治疗的患者HBeAg/抗-HBe血清学转换率（9/17，52.9%）高于接受拉米夫定联合苦参素治疗的患者（5/16，31.3%，P<0.05），后者高于单独接受拉米夫定治疗的患者（1/17，5.9%，P<0.01）；接受拉米夫定治疗患者的Knodell组织学活动指数评分（7.2±0.8，P<0.05）低于接受干扰素α治疗的患者（8.2±1.3，P<0.05），联合治疗疗效最佳（6.9±0.7，P<0.01）；拉米夫定或拉米夫定联合苦参素显著抑制B组患者肝内炎症活动，但对已有的肝纤维化无影响。