Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
Hepatobiliary Pancreat Dis Int. 2013 Apr;12(2):154-9. doi: 10.1016/s1499-3872(13)60025-9.
Selection of drugs for antiviral therapy of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) remains difficult. This study was undertaken to evaluate the short-term efficacy of entecavir versus lamivudine on hepatitis B e antigen (HBeAg)-negative patients with ACLF.
The data of 182 HBeAg-negative patients with ACLF were retrospectively collected from patient profiles of the hospital. In these patients, 93 HBeAg-negative patients with ACLF were treated orally with 0.5 mg of entecavir and 89 were treated orally with 100 mg of lamivudine every day. The gender and age were matched between the two groups. Biochemical items, the model for end-stage liver disease (MELD) score, and HBV DNA level were matched at baseline between the two groups and monitored during treatment. The 3-month mortalities of the two groups were compared.
No significant differences were found in biochemical items, MELD score, and HBV DNA level at baseline (P>0.05). HBV DNA level decreased within 3 months in both groups (P<0.05), regardless of the pretreatment MELD score. In patients with the same range of pretreatment MELD scores, treatment duration, posttreatment HBV DNA levels, percentage of HBV DNA level <2.7 lg copies/mL, biochemical items, MELD scores and 3-month mortality were similar in the two groups (all P>0.05). Pretreatment MELD score was not related to posttreatment HBV DNA levels (P>0.05), but related to a 3-month mortality in both groups (both P<0.001).
In HBeAg-negative patients with ACLF, the short-term efficacy of entecavir versus lamivudine was similar. The degree of pretreatment liver failure significantly affected the outcome of treatment.
乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者的抗病毒治疗药物选择仍然困难。本研究旨在评估恩替卡韦与拉米夫定治疗 HBeAg 阴性 ACLF 患者的短期疗效。
回顾性收集了医院患者病历中的 182 例 HBeAg 阴性 ACLF 患者的数据。在这些患者中，93 例 HBeAg 阴性 ACLF 患者每天口服 0.5 mg 恩替卡韦，89 例口服 100 mg 拉米夫定。两组的性别和年龄相匹配。两组在基线时匹配了生化指标、终末期肝病模型（MELD）评分和 HBV DNA 水平，并在治疗过程中进行了监测。比较了两组的 3 个月死亡率。
两组在基线时的生化指标、MELD 评分和 HBV DNA 水平均无显著差异（P>0.05）。两组 HBV DNA 水平均在 3 个月内下降（P<0.05），与预处理 MELD 评分无关。在预处理 MELD 评分相同的患者中，两组的治疗持续时间、治疗后 HBV DNA 水平、HBV DNA 水平<2.7 lg 拷贝/ml 的百分比、生化指标、MELD 评分和 3 个月死亡率相似（均 P>0.05）。预处理 MELD 评分与治疗后 HBV DNA 水平无关（P>0.05），但与两组 3 个月死亡率均相关（均 P<0.001）。
在 HBeAg 阴性 ACLF 患者中，恩替卡韦与拉米夫定的短期疗效相似。肝衰竭的严重程度显著影响治疗结果。
