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目的观察抗病毒治疗对失代偿肝硬化患者生存时间及肝癌发生的影响。方法回顾性分析1998年1月~2009年12月,于北京地坛医院住院至少3次或3次以上的HBV感染相关的失代偿肝硬化患者,抗病毒治疗对其预后的影响。所有分析对象是在最后1次住院期间死亡的患者。其中男168例,女69例。237例患者中70例患者接受了连续6个月以上的抗病毒治疗。耐药检测采用PCR法扩增病毒聚合酶相应的基因片段,并进行测序分析。结果接受核苷类似物抗病毒治疗的70例患者生存时间(34.44±28.39)个月,显著长于未接受治疗的患者(27.12±24.29)个月。167例未接受抗病毒治疗的失代偿肝硬化患者中,最终60例死亡前被确诊为肝癌,发生率为35.93%(60/167);而接受抗病毒治疗的70例患者中,20例死亡前被确诊为肝癌,肝癌发生率为28.57%(20/70)。两组比较无显著性差异(P=0.37)。治疗期间6例患者出现耐药,但未出现病情加重。结论核苷类似物对HBV感染失代偿肝硬化患者的治疗有助于延长患者的生存期,但不能降低肝癌的发生。
Objective To observe the effect of antiviral therapy on the survival time and the incidence of liver cancer in patients with decompensated cirrhosis. Methods A retrospective analysis of January 1998 ~ December 2009, at Beijing Ditan Hospital hospitalized at least three times or more HBV infection-related decompensated cirrhosis patients, the impact of antiviral therapy on its prognosis. All subjects were those who died during the last hospitalization. There were 168 males and 69 females. Of the 237 patients, 70 patients received antiviral therapy for more than 6 months. Drug resistance test using PCR amplification of the corresponding gene fragments of the viral polymerase, and sequencing analysis. Results The survival time of the 70 patients receiving nucleoside analog anti-virus therapy was 34.44 ± 28.39 months, significantly longer than that of the untreated patients (27.12 ± 24.29) months. Among the 167 patients with decompensated cirrhosis who did not receive antiviral therapy, the final 60 patients were diagnosed with liver cancer before the death, the incidence rate was 35.93% (60/167); of the 70 patients receiving antiviral therapy, 20 Before death was diagnosed with liver cancer, the incidence of liver cancer was 28.57% (20/70). There was no significant difference between the two groups (P = 0.37). Six patients developed resistance during the course of treatment, but no exacerbations occurred. Conclusion Nucleoside analogue treatment of HBV-infected patients with decompensated cirrhosis can prolong the survival of patients, but can not reduce the incidence of liver cancer.