替比夫定治疗 96 周时初治的乙型肝炎病毒相关代偿和失代偿肝硬化患者的疗效比较。
Comparison of telbivudine efficacy in treatment-naive patients with hepatitis B virus-related compensated and decompensated cirrhosis in 96 weeks.
机构信息
aGraduate School, Tianjin Medical University bTianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin, China.
出版信息
Eur J Gastroenterol Hepatol. 2014 Apr;26(4):396-403. doi: 10.1097/MEG.0000000000000062.
OBJECTIVE
Data are limited for comparison of the long-term efficacy of telbivudine (LdT) between hepatitis B virus (HBV)-related compensated and decompensated cirrhosis. The aim of this study was to compare the efficacy of LdT in treatment-naive patients with HBV-related compensated and decompensated cirrhosis in 96 weeks.
PATIENTS AND METHODS
We reviewed the data of 65 compensated and 62 decompensated cirrhotic patients treated with LdT for 96 weeks, and compared the difference in the related indicators before and after treatment between the groups.
RESULTS
Alanine aminotransferase normalized rate was significantly higher in the compensated group than in the decompensated group at weeks 12 and 24 (67.7 vs. 40.3% and 78.5 vs. 53.2%, respectively, P<0.01). Albumin level was much higher than the baseline at week 24 in the compensated group (35.1±6.2 vs. 39.9±5.1, P<0.01), but significance was observed from week 48 onwards in the decompensated group (29.8±3.7 vs. 33.7±3.8, P<0.05). The Child-Turcotte-Puge score either improved or remained steady in both groups. The HBV DNA negativity rate at week 12 (56.9 vs. 32.3%, P<0.01) was higher, whereas the drug resistance rate was lower (P>0.05), in the compensated group than in the decompensated group. The degree of esophageal varix was alleviated, including 11 (16.9%) compensated and four (6.5%) decompensated cirrhotic patients. Liver stiffness was significantly decreased in the compensated group compared with the baseline [19.1 (7.3-32.6) vs. 14.8 (7.4-32.5), P<0.01]; however, there was no statistical significance in the decompensated group compared with the baseline [30.5 (9.1-55.0) vs. 29.9 (8.4-53.2), P>0.05].
CONCLUSION
Long-term LdT treatment showed superior virological, biochemical, and clinical efficacy in the compensated cirrhotic patients. Therefore, we emphasized the importance of early antiviral treatment, which may improve the prognosis of cirrhotic patients.
目的
用于比较替比夫定（LdT）治疗乙型肝炎病毒（HBV）相关代偿和失代偿性肝硬化的长期疗效的数据有限。本研究的目的是比较替比夫定治疗初治 HBV 相关代偿和失代偿性肝硬化患者 96 周的疗效。
患者和方法
我们回顾了 65 例代偿性和 62 例失代偿性肝硬化患者接受替比夫定治疗 96 周的数据，并比较了两组患者治疗前后相关指标的差异。
结果
在第 12 周和 24 周时，代偿组的丙氨酸氨基转移酶正常率显著高于失代偿组（分别为 67.7%和 78.5% vs. 40.3%和 53.2%，P<0.01）。代偿组的白蛋白水平在第 24 周时明显高于基线水平（35.1±6.2 vs. 39.9±5.1，P<0.01），但失代偿组从第 48 周开始出现显著升高（29.8±3.7 vs. 33.7±3.8，P<0.05）。两组患者的 Child-Turcotte-Puge 评分均有改善或保持稳定。代偿组在第 12 周时 HBV DNA 阴转率更高（56.9% vs. 32.3%，P<0.01），而耐药率更低（P>0.05）。食管静脉曲张程度得到缓解，包括 11 例（16.9%）代偿性和 4 例（6.5%）失代偿性肝硬化患者。与基线相比，代偿组的肝硬度显著降低[19.1（7.3-32.6）vs. 14.8（7.4-32.5），P<0.01]；而失代偿组与基线相比无统计学意义[30.5（9.1-55.0）vs. 29.9（8.4-53.2），P>0.05]。
结论
替比夫定长期治疗在代偿性肝硬化患者中具有更好的病毒学、生化学和临床疗效。因此，我们强调早期抗病毒治疗的重要性，这可能改善肝硬化患者的预后。
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