Immunosuppressive treatment combined with nucleoside analog is superior to nucleoside analog only in the treatment of severe thrombocytopenia in patients with cirrhosis associated with hepatitis B in China: A multicenter, observational study
Immunosuppressive treatment combined with nucleoside analog is superior to nucleoside analog only in the treatment of severe thrombocytopenia in patients with cirrhosis associated with hepatitis B in China: A multicenter, observational study
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DOI：
10.3109/09537104.2014.979339
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发表时间：
2015-10
期刊：
影响因子：
3.3
通讯作者：
X. Zhang;R. Feng;Lanping Xu;Q. Jiang;Hao Jiang;H. Fu;Hui Liu;T. Niu;Xin Wang;Jianda Hu;M. Jiang;Zhao Wang;Jing Wang;Hui Ma;Yandi Xie;Xiao Zhu;Hao Wang;Lai Wei;Xiao-jun Huang
中科院分区：
文献类型：
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作者：
X. Zhang;R. Feng;Lanping Xu;Q. Jiang;Hao Jiang;H. Fu;Hui Liu;T. Niu;Xin Wang;Jianda Hu;M. Jiang;Zhao Wang;Jing Wang;Hui Ma;Yandi Xie;Xiao Zhu;Hao Wang;Lai Wei;Xiao-jun Huang
肝硬化（LC）合并乙型肝炎病毒（HBV）和严重血小板减少症患者尚无有效的治疗方法。本研究旨在探讨低剂量强的松或环孢素A （CsA）联合核苷类似物（NA）治疗hbv相关LC伴严重血小板减少患者的有效性和安全性。我们纳入了145例2006年1月1日至2013年12月31日期间伴有严重血小板减少症的连续代偿性hbv相关LC患者。根据治疗策略将患者分为三组，分别为单纯NA组（n = 57）、NA +强的松组（n = 46）和NA + CsA组（n = 42）。我们分析了各组的血小板计数、出血事件、肝功能、HBV复制和结局。在观察的所有时间点，泼尼松组或CsA组血小板计数均高于单纯NA组。三组间出血事件的累积发生率有显著差异。在多变量分析中，血小板计数和治疗是与出血事件相关的因素。各组间HBV-DNA阴性率、HBV-DNA升高率、正常血清丙氨酸转氨酶率、血清丙氨酸转氨酶升高2倍以上基线率、HBeAg血清阳性转换率差异均无统计学意义。总的来说，我们研究中的不良事件在三个治疗组中是轻微和平衡的。低剂量强的松或CsA加NA治疗可以提高血小板计数，降低严重血小板减少的HBV LC出血事件的风险。
Abstract No effective treatment has been identified for patients of liver cirrhosis (LC) associated with hepatitis B virus (HBV) and severe thrombocytopenia. We aimed to explore the effectiveness and safety of low-dose prednisone or cyclosporine A (CsA) combined with nucleoside analog (NA) in patients with severe thrombocytopenia associated with HBV-related LC. We included 145 consecutive compensated HBV-associated LC patients with severe thrombocytopenia between 1 January 2006 and 31 December 2013. We divided the patients into three groups by treatment strategy, including NA only (n = 57), NA plus prednisone (n = 46), and NA plus CsA (n = 42). We analyzed the platelet counts, bleeding events, liver function, replication of HBV, and outcomes in each group. At all time points during this observation, the platelet counts in prednisone or CsA group were higher than those in the NA only group. There are significant differences in the cumulative rates of bleeding events among the three groups. The platelet counts and treatment were factors associated with bleeding events in multivariate analysis. The differences in HBV-DNA negative rates, HBV-DNA elevated rates, normal serum alanine transaminase rates, serum alanine transaminase elevated more than two times the baseline rates, and HBeAg seropositive conversion ratio among the groups did not reach statistical significance. The adverse events in our study were, in general, mild and balanced among the three treatment groups. Treatment with low-dose prednisone or CsA plus NA could elevate the platelet counts and reduce the risk of bleeding events in HBV LC with severe thrombocytopenia.