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目的:探讨抗病毒治疗乙型肝炎相关慢加急性肝衰竭(acute on chronic liver failure,ACLF)的临床意义。方法:回顾性分析2007年8月~2013年8月我院收治的乙型肝炎相关慢加急性肝衰竭的住院患者80例,按照患者有无接受抗病毒治疗分为抗病毒治疗组(A组)50例和未抗病毒治疗组(B组)30例,分析患者接受治疗后的近期与远期疗效、并发症及生存率。结果:1出院时A组好转率70%;B组好转率33.3%。两组比较差异有统计学意义(x2=10.243,P=0.001<0.05)。2治疗14周后A组乙肝病毒DNA阴转率72%;B组阴转率30%,两组比较差异有统计学意义(x2=13.440,P=0.000<0.05)。3A组出现细菌感染45例,电解质紊乱41例,消化道出血5例,肝性脑病10例,肝肾综合征10例,B组出现细菌感染30例,电解质紊乱27例,消化道出血6例,肝性脑病10例,肝肾综合征12例,两组比较差异无统计学意义(x2=2.755,P=0.097>0.05)。4随访5年,A组存活36例,死亡14例,12、36和60个月累积生存率分别为78.5%、71.2%、71.2%,B组存活5例,死亡25例,12、36和60个月累积生存率分别为35.4%、27.5%、27.5%,两组比较差异有统计学意义(P<0.05)。结论:对乙型肝炎相关慢加急性肝衰竭患者给予抗病毒治疗可明显改善预后,提高生存率。
Objective: To investigate the clinical significance of antiviral treatment of acute on chronic liver failure (ACLF). Methods: A retrospective analysis of 80 patients admitted to our hospital from August 2007 to August 2013 in our hospital with chronic hepatitis B-related acute and acute hepatic failure was divided into group A (anti-virus treatment group) ) 50 cases and no anti-virus treatment group (B group) 30 cases, analysis of patients receiving treatment of short-term and long-term efficacy, complications and survival. Results: The rate of improvement in group A was 70% at discharge and that in group B was 33.3%. The difference between the two groups was statistically significant (x2 = 10.243, P = 0.001 <0.05). 2 After 14 weeks of treatment, the negative conversion rate of HBV DNA in group A was 72%. The negative conversion rate of group B was 30%. There was significant difference between the two groups (x2 = 13.440, P = 0.000 <0.05). In group 3A, there were 45 cases of bacterial infection, 41 cases of electrolyte disturbance, 5 cases of gastrointestinal bleeding, 10 cases of hepatic encephalopathy, 10 cases of hepatorenal syndrome, 30 cases of bacterial infection in group B, 27 cases of electrolyte disturbance and 6 cases of gastrointestinal bleeding , 10 cases of hepatic encephalopathy and 12 cases of hepatorenal syndrome. There was no significant difference between the two groups (χ2 = 2.755, P = 0.097> 0.05). In the follow-up of 5 years, group A survived 36 cases and died 14 cases. The cumulative survival rates at 12, 36 and 60 months were 78.5%, 71.2% and 71.2% respectively. Five patients survived in group B, 25 died, 12 and 36 The cumulative survival rates at 60 months were 35.4%, 27.5% and 27.5%, respectively, with significant difference between the two groups (P <0.05). Conclusion: Antiviral treatment of patients with chronic hepatitis B and acute liver failure can significantly improve the prognosis and improve the survival rate.