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[恩替卡韦抗病毒治疗乙型肝炎病毒相关性失代偿期肝硬化患者并发症的代偿情况]

[Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy].

作者信息

Zhang T, Deng Y, Kang H Y, Xiang H L, Nan Y M, Hu J H, Meng Q H, Fang J L, Xu J, Wang X M, Zhao H, Pan C Q, Jia J D, Xu X Y, Xie W

机构信息

Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.

The Sixth Department of Infectious Diseases, Shijiazhuang Fifth Hospital, Shijiazhuang 050021, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2023 Jul 20;31(7):692-697. doi: 10.3760/cma.j.cn501113-20230324-00126.

Abstract

To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student -test or Mann-Whitney U test between groups. Categorical data were compared by the (2) test or Fisher's exact probability method between groups. 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, = 12.70, < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, = 5.963, < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), (2) = 5.275, = 0.029]. Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

摘要

分析恩替卡韦抗病毒治疗后慢性乙型肝炎病毒相关性失代偿期肝硬化患者再代偿情况的发生。前瞻性纳入以腹水为初始表现的乙型肝炎病毒相关性失代偿期肝硬化患者。对接受恩替卡韦治疗120周且每24周进行随访(包括临床终点事件、血液学和影像学指标等)的患者,根据巴韦诺VII标准计算再代偿率。组间计量资料比较采用Student检验或Mann-Whitney U检验。组间分类资料比较采用χ²检验或Fisher确切概率法。320例纳入病例中283例完成120周随访,92.2%(261/283)实现病毒学应答(HBV DNA<20 IU/ml)。治疗后Child-Pugh和MELD评分显著改善(8.33±1.90 vs. 5.77±1.37,t = 12.70,P<0.001;13.37±4.44 vs. 10.45±4.58,t = 5.963,P<0.001)。在120周随访期间,14例死亡,2例接受肝移植,19例发生肝细胞癌,11例发生食管胃静脉曲张出血,4例发生肝性脑病。60.4%(171/283)(12个月内无失代偿事件发生)和56.2%(159/283)(12个月内无失代偿事件发生且肝功能改善)的患者在120周内实现了临床再代偿。积极抗病毒治疗后基线MELD评分>15的患者比基线MELD评分≤15的患者再代偿率更高[50/74(67.6%)vs. 109/209(52.2%),χ² = 5.275,P = 0.029]。抗病毒治疗可显著改善乙型肝炎病毒相关性失代偿期肝硬化患者的预后。大多数患者(56.2%)实现了再代偿。基线病情严重的患者再代偿概率并不低于其他患者。

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