Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Hepatol. 2014 Jun;60(6):1127-34. doi: 10.1016/j.jhep.2014.02.013. Epub 2014 Feb 26.
BACKGROUND & AIMS: We compared the mortality and treatment response between lamivudine (LAM) and entecavir (ETV) in chronic hepatitis B (CHB) patients with severe acute exacerbation and hepatic decompensation.
From 2003 to 2010 (the LAM group) and 2008 to 2010 (the ETV group), 215 and 107 consecutive CHB naïve patients with severe acute exacerbation and hepatic decompensation treated with LAM and ETV respectively, were recruited.
At baseline, the LAM group had higher AST levels and end-stage liver disease (MELD) scores, and lower albumin levels than the ETV group. Univariate analysis showed that the LAM group had a higher rate of overall (p=0.02) and liver-related mortality (p=0.052) at week 24 than the ETV group, including in patients with acute-on-chronic liver failure. Multivariate analysis showed that MELD scores, ascites, and hepatic encephalopathy were independent factors for overall and liver-related mortality at week 24. ETV or LAM treatment was not an independent factor for mortality in all patients or patients with acute-on-chronic liver failure. The best cut-off value of MELD scores were 24 for 24-week liver-related mortality. The ETV group achieved better virological response (HBV DNA <300 copies/ml) than the LAM group at week 24 (p=0.043) and 48 (p=0.007). The T1753C/A mutation was also an independent predictor associated with overall and liver-related mortality at week 24.
The choice between ETV and LAM was not an independent factor for mortality in CHB patients with acute exacerbation and hepatic decompensation. Patients with ascites, hepatic encephalopathy, and MELD scores ⩾24 were associated with poor outcome and should be considered for liver transplantation.
我们比较了拉米夫定（LAM）和恩替卡韦（ETV）在伴有严重急性加重和肝功能失代偿的慢性乙型肝炎（CHB）患者中的死亡率和治疗反应。
2003 年至 2010 年（LAM 组）和 2008 年至 2010 年（ETV 组），分别连续纳入 215 例和 107 例接受 LAM 和 ETV 治疗的伴有严重急性加重和肝功能失代偿的初治 CHB 患者。
基线时，LAM 组 AST 水平和终末期肝病评分（MELD）较高，白蛋白水平较低。单因素分析显示，与 ETV 组相比，LAM 组在第 24 周的总死亡率（p=0.02）和肝相关死亡率（p=0.052）更高，包括在慢加急性肝衰竭患者中。多因素分析显示，MELD 评分、腹水和肝性脑病是第 24 周总死亡率和肝相关死亡率的独立因素。在所有患者或慢加急性肝衰竭患者中，ETV 或 LAM 治疗均不是死亡率的独立因素。MELD 评分最佳截断值为 24，预测第 24 周肝相关死亡率。与 LAM 组相比，ETV 组在第 24 周（p=0.043）和第 48 周（p=0.007）时病毒学应答（HBV DNA<300 拷贝/ml）更好。T1753C/A 突变也是第 24 周总死亡率和肝相关死亡率的独立预测因子。
在伴有急性加重和肝功能失代偿的 CHB 患者中，选择 ETV 和 LAM 不是死亡率的独立因素。有腹水、肝性脑病和 MELD 评分 ⩾24 的患者预后不良，应考虑进行肝移植。
