恩替卡韦联合糖皮质激素在早期乙型肝炎相关肝衰竭中的应用分析
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摘要
目的探讨恩替卡韦联合糖皮质激素在早期乙型肝炎相关肝衰竭中的应用效果。方法纳入2016年1月～2017年11月90例早期乙型肝炎相关肝衰竭患者以随机数字表法分组。对照组采用恩替卡韦进行治疗,观察组采用恩替卡韦联合糖皮质激素治疗。比较两组早期乙型肝炎相关肝衰竭治疗效果;平均住院时间;干预前后患者血清ALB、TBIL、AST和ALT、凝血酶原时间;不良反应发生率;HBV-DNA转阴率和HBeAg转阴率。结果观察组早期乙型肝炎相关肝衰竭治疗效果高于对照组,差异有统计学意义(P <0.05);观察组平均住院时间短于对照组,差异有统计学意义(P <0.05);干预前两组血清ALB、TBIL、AST和ALT、凝血酶原时间相近,差异无统计学意义(P> 0.05);干预后观察组血清ALB、TBIL、AST和ALT、凝血酶原时间优于对照组,差异有统计学意义(P <0.05)。观察组不良反应少于对照组,差异有统计学意义(P<0.05);观察组HBV-DNA转阴率和HBeAg转阴率与对照组比较,差异无统计学意义(P> 0.05)。结论恩替卡韦联合糖皮质激素在早期乙型肝炎相关肝衰竭中的应用效果确切,可有效改善临床症状,减少并发症,改善肝功能,缩短住院时间,值得推广应用。
Objective To investigate the effect of entecavir combined with glucocorticoids in the early hepatitis B related liver failure. Methods Ninety patients with early hepatitis B related liver failure from January 2016 to November 2017 were included and grouped by digital table. The control group was treated with entecavir. The observation group was treated with entecavir and glucocorticoid. The treatment effect of hepatitis B related liver failure, the average length of hospital stay, serum ALB, TBIL, AST and ALT, prothrombin time, incidence of adverse reactions, HBV-DNA negative rate and HBeAg negative rate before and after intervention were compared between two groups. Results The therapeutic effect of early hepatitis B related liver failure in the observation group was better than that in the control group(P < 0.05); The average length of stay in the observation group was shorter than that in the control group(P < 0.05); The levels of serum ALB, TBIL, AST and ALT and prothrombin time were similar in the two groups before intervention(P > 0.05); The levels of serum ALB, TBIL, AST and ALT and prothrombin time in observation group were better than those in control group after intervention(P < 0.05). Adverse reaction in the observation group was less than that in the control group(P < 0.05). There was no significant difference in HBV-DNA negative rate and HBeAg negative rate between the observation group and the control group(P > 0.05). Conclusion The effect of entecavir combined with glucocorticoids in the early hepatitis B related liver failure is effective, which can effectively improve clinical symptoms, reduce complications, improve liver function and shorten the length of hospital stay, which is worth popularizing and applying.
Objective To investigate the effect of entecavir combined with glucocorticoids in the early hepatitis B related liver failure. Methods Ninety patients with early hepatitis B related liver failure from January 2016 to November 2017 were included and grouped by digital table. The control group was treated with entecavir. The observation group was treated with entecavir and glucocorticoid. The treatment effect of hepatitis B related liver failure, the average length of hospital stay, serum ALB, TBIL, AST and ALT, prothrombin time, incidence of adverse reactions, HBV-DNA negative rate and HBeAg negative rate before and after intervention were compared between two groups. Results The therapeutic effect of early hepatitis B related liver failure in the observation group was better than that in the control group(P < 0.05); The average length of stay in the observation group was shorter than that in the control group(P < 0.05); The levels of serum ALB, TBIL, AST and ALT and prothrombin time were similar in the two groups before intervention(P > 0.05); The levels of serum ALB, TBIL, AST and ALT and prothrombin time in observation group were better than those in control group after intervention(P < 0.05). Adverse reaction in the observation group was less than that in the control group(P < 0.05). There was no significant difference in HBV-DNA negative rate and HBeAg negative rate between the observation group and the control group(P > 0.05). Conclusion The effect of entecavir combined with glucocorticoids in the early hepatitis B related liver failure is effective, which can effectively improve clinical symptoms, reduce complications, improve liver function and shorten the length of hospital stay, which is worth popularizing and applying.
引文
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[8]虞胜,祝峻峰,陈建杰,等.清化凉血化瘀方治疗乙型肝炎相关性慢加急性(亚急性)肝功能衰竭患者的临床疗效[J].中国肝脏病杂志(电子版),2016,8(2):52-57.
[9]戴小灵,钟远辉.恩替卡韦联合甲基强的松龙冲击治疗乙型肝炎慢加急性肝衰竭的临床效果[J].河北医药,2013,35(7):1031-1032.
[10]赵文革,马艳丽.恩替卡韦和拉米夫定治疗乙型慢加急性肝衰竭3年疗效的对比研究[J].中国医药,2012,7(2):169-171.
[11]Jalan,Rajiv,Pavesi,et al.The CLIF Consortium Acute Decompensation score(CLIF-C ADs)for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure[J].Journal of Hepatology:The Journal of the European Association for the Study of the Liver,2015,62(4):831-840.
[12]林佃相,刘颖翰,石栓柱,等.恩替卡韦联合复方鳖甲软肝片对代偿期乙肝肝硬化患者肝纤维化程度的影响[J].河北医药,2016,38(11):1639-1641.
[13]戴玮玮,冯艳红,常家宝,等.恩替卡韦联合复方鳖甲软肝片治疗肝硬化的临床观察[J].甘肃中医,2011,24(2):28-29.
[14]宋春霞,张伯鹏,阎志欣,等.恩替卡韦联合柔肝散结汤治疗慢性乙型病毒性肝炎肝硬化疗效观察[J].河北中医,2010,32(8):1171-1173.
[15]程乾刚,王亚静,朱美芬,等.恩替卡韦联合糖皮质激素治疗重度慢性乙型肝肝炎的临床分析[J].海峡药学,2013,25(3):138-140.
[2]张绍全,雷姿颖,陈俊峰,等.短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率[J].中山大学学报(医学科学版),2014,35(1):67-73.
[3]Lee,Karla CL,Baker,et al.Extracorporeal liver assist device to exchange albumin and remove endotoxin in acute liver failure:Results of a pivotal pre-clinical study[J].Journal of Hepatology:The Journal of the European Association for the Study of the Liver,2015,63(3):634-642.
[4]陈铿,曹欣,郑茵,等.MELD-Na与CTP评分评估乙型肝炎慢加急性肝衰竭短期预后的对比研究[J].中华肝脏病杂志,2014,22(11):801-805.
[5]叶非,过建春,裘云庆,等.恩替卡韦、拉米夫定治疗HBeAg阴性乙型肝炎相关慢加急性肝衰竭12周疗效比较[J].中华实验和临床病毒学杂志,2014,28(3):209-212.
[6]赵振刚,韩涛,高英堂,等.乙型肝炎患者并发慢加急性肝衰竭诱因及转归分析289例[J].世界华人消化杂志,2009,17(31):3269-3272
[7]McPhail,Mark JW,Shawcross,et al.Increased Survival for Patients With Cirrhosis and Organ Failure in Liver Intensive Care and Validation of the Chronic Liver Failure Sequential Organ Failure Scoring System[J].Clinical Gastroenterology and Hepatology:the Official Clinical Practice Journal of the American Gastroenterological Association,2015,13(7):1353.
[8]虞胜,祝峻峰,陈建杰,等.清化凉血化瘀方治疗乙型肝炎相关性慢加急性(亚急性)肝功能衰竭患者的临床疗效[J].中国肝脏病杂志(电子版),2016,8(2):52-57.
[9]戴小灵,钟远辉.恩替卡韦联合甲基强的松龙冲击治疗乙型肝炎慢加急性肝衰竭的临床效果[J].河北医药,2013,35(7):1031-1032.
[10]赵文革,马艳丽.恩替卡韦和拉米夫定治疗乙型慢加急性肝衰竭3年疗效的对比研究[J].中国医药,2012,7(2):169-171.
[11]Jalan,Rajiv,Pavesi,et al.The CLIF Consortium Acute Decompensation score(CLIF-C ADs)for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure[J].Journal of Hepatology:The Journal of the European Association for the Study of the Liver,2015,62(4):831-840.
[12]林佃相,刘颖翰,石栓柱,等.恩替卡韦联合复方鳖甲软肝片对代偿期乙肝肝硬化患者肝纤维化程度的影响[J].河北医药,2016,38(11):1639-1641.
[13]戴玮玮,冯艳红,常家宝,等.恩替卡韦联合复方鳖甲软肝片治疗肝硬化的临床观察[J].甘肃中医,2011,24(2):28-29.
[14]宋春霞,张伯鹏,阎志欣,等.恩替卡韦联合柔肝散结汤治疗慢性乙型病毒性肝炎肝硬化疗效观察[J].河北中医,2010,32(8):1171-1173.
[15]程乾刚,王亚静,朱美芬,等.恩替卡韦联合糖皮质激素治疗重度慢性乙型肝肝炎的临床分析[J].海峡药学,2013,25(3):138-140.