Nucleoside Analogue Can Improve the Long-Term Prognosis of Patients with Hepatitis B Virus Infection-Associated Acute on Chronic Liver Failure
Nucleoside Analogue Can Improve the Long-Term Prognosis of Patients with Hepatitis B Virus Infection-Associated Acute on Chronic Liver Failure
复制标题
核苷类似物可改善乙型肝炎病毒感染相关急性慢性肝衰竭患者的长期预后
DOI：
10.1007/s10620-010-1257-7
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发表时间：
2010-08-01
影响因子：
3.1
通讯作者：
Feng, Ping
中科院分区：
文献类型：
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作者：
Cui, Yao-Li;Yan, Fang;Feng, Ping
乙型肝炎病毒（HBV）相关的慢加急性肝衰竭（ACLF）患者的预后极差。本研究旨在评估核苷类似物治疗HBV相关ACLF患者的疗效和安全性。我们对2006年4月至2008年12月符合条件的患者进行了回顾性研究。符合条件的受试者在2009年10月前每日接受0.5mg恩替卡韦治疗（A组），每日接受100mg拉米夫定治疗（B组），或不使用核苷类似物（C组）。主要终点是3个月生存率和HBV相关ACLF的复发率。次要终点是HBV DNA水平、肝功能、终末期肝病模型（MELD）评分以及不良事件。共招募了104例连续患者，其中33例、34例和37例患者分别随机分配到A组、B组和C组。尽管3个月生存率无显著差异，但HBV DNA水平和HBV相关ACLF的复发率较低。尽管HBV DNA水平显著降低，但肝功能和MELD评分并无显著改善。这些数据表明，核苷类似物治疗虽然在控制HBV DNA水平方面有效且安全，但并未改善HBV相关ACLF患者的短期预后。有趣且重要的是，持续的核苷类似物治疗可显著降低复发率，这可能预示着对长期生存有进一步的益处。
The prognosis of patients with hepatitis B virus (HBV)-associated acute on chronic liver failure (ACLF) is extremely poor.This study was designed to evaluate the efficacy and safety of nucleoside analogue treatment of patients with HBV-associated ACLF.We used a retrospective review of eligible patients from April 2006 to December 2008. Eligible subjects received 0.5 mg entecavir daily until October 2009 (group A), 100 mg lamivudine daily until October 2009 (group B), or no nucleoside analogue (group C). The primary endpoints were three-month survival and the rate of recurrence of HBV-associated ACLF. The secondary endpoints were HBV DNA levels, liver function, the model of end-stage liver disease (MELD) score, and adverse events.A total of 104 consecutive patients were recruited, and 33, 34, and 37 patients were randomly allocated to groups A, B, and C, respectively. Although no significant difference in three-month survival was observed, levels of HBV DNA and rates of recurrence of HBV-associated ACLF were lower. Liver function and MELD score were not significantly improved despite significantly reduced HBV DNA levels.These data indicated that nucleoside analogue treatment did not improve the short-term prognosis of patients with HBV-associated ACLF although it was efficacious and safe in the management of HBV DNA levels. Intriguingly and importantly, continuous nucleoside analogue treatment can significantly reduce the rate of recurrence, which might be indicative of the further benefit of long-term survival.