Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
World J Gastroenterol. 2012 Sep 7;18(33):4604-9. doi: 10.3748/wjg.v18.i33.4604.
To investigate optimal timing for therapeutic efficacy of entecavir for acute-on-chronic hepatitis B liver failure (ACLF-HBV) in hepatitis B e antigen (HBeAg)-negative patients.
A total of 109 inpatients with ACLF-HBV were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University from October 2007 to October 2010. Entecavir 0.5 mg/d was added to each patient's comprehensive therapeutic regimen. Patients were divided into three groups according to model for end-stage liver disease (MELD) score: high (≥ 30, 20 males and 4 females, mean age 47.8 ± 13.5 years); intermediate (22-30, 49 males and 5 females, 45.9 ± 12.4 years); and low (≤ 22, 28 males and 3 females, 43.4 ± 9.4 years). Statistical analysis were performed using SPSS 11.0 software. Data with normal distribution were expressed as mean ± SD and comparisons were made with Student's t tests. A value of P < 0.05 was considered statistically significant. Viral loads were related exponentially and logarithmic data were used for analysis.
For 24 patients with MELD score ≥ 30, treatment lasted 17.2 ± 16.5 d. Scores before and after treatment were significantly different (35.97 ± 4.87 and 40.48 ± 8.17, respectively, t = -2.762, P = 0.011); HBV DNA load was reduced (4.882 ± 1.847 copies log(10)/mL to 3.685 ± 1.436 copies log(10)/mL); and mortality rate was 95.83% (23/24). Of 54 patients with scores of 22-30, treatment lasted for 54.0 ± 43.2 d; scores before and after treatment were 25.87 ± 2.33 and 25.82 ± 13.92, respectively (t = -0.030, P = 0.976); HBV DNA load decreased from 6.308 ± 1.607 to 3.473 ± 2.097 copies log(10)/mL; and mortality was 51.85% (28/54). Of 31 patients with scores ≤ 22, treatment lasted for 66.1 ± 41.9 d; scores before and after treatment were 18.88 ± 2.44 and 12.39 ± 7.80, respectively, (t = 4.860, P = 0.000); HBV DNA load decreased from 5.841 ± 1.734 to 2.657 ± 1.154 copies log(10)/mL; and mortality was 3.23% (1/31).
For HBeAg-negative patients with ACLF-HBV, when entecavir was added to comprehensive therapy, a MELD score ≥ 30 predicted very poor prognosis due to fatal liver failure.
研究乙型肝炎 e 抗原（HBeAg）阴性的慢加急性肝衰竭（HBV-ACLF）患者恩替卡韦治疗的最佳时机。
2007 年 10 月至 2010 年 10 月，中山大学附属第三医院感染科共收治 109 例 HBV-ACLF 患者。每位患者的综合治疗方案中均加入恩替卡韦 0.5mg/d。根据终末期肝病模型（MELD）评分将患者分为三组：高（≥30，20 男 4 女，平均年龄 47.8±13.5 岁）；中（22-30，49 男 5 女，平均年龄 45.9±12.4 岁）；低（≤22，28 男 3 女，平均年龄 43.4±9.4 岁）。采用 SPSS 11.0 软件进行统计学分析。正态分布数据用均数±标准差表示，采用学生 t 检验进行比较。P＜0.05 认为差异有统计学意义。病毒载量呈指数相关，对数数据用于分析。
MELD 评分≥30 的 24 例患者，治疗时间为 17.2±16.5d。治疗前后评分差异有统计学意义（分别为 35.97±4.87 和 40.48±8.17，t=-2.762，P=0.011）；HBV DNA 载量降低（从 4.882±1.847 拷贝对数 10/ml 降至 3.685±1.436 拷贝对数 10/ml）；死亡率为 95.83%（23/24）。MELD 评分为 22-30 的 54 例患者，治疗时间为 54.0±43.2d；治疗前后评分分别为 25.87±2.33 和 25.82±13.92（t=-0.030，P=0.976）；HBV DNA 载量从 6.308±1.607 拷贝对数 10/ml 降至 3.473±2.097 拷贝对数 10/ml；死亡率为 51.85%（28/54）。MELD 评分≤22 的 31 例患者，治疗时间为 66.1±41.9d；治疗前后评分分别为 18.88±2.44 和 12.39±7.80（t=4.860，P=0.000）；HBV DNA 载量从 5.841±1.734 拷贝对数 10/ml 降至 2.657±1.154 拷贝对数 10/ml；死亡率为 3.23%（1/31）。
对于 HBeAg 阴性的 ACLF-HBV 患者，当恩替卡韦加入综合治疗时，MELD 评分≥30 预测肝衰竭死亡率极高。
