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目的探讨系统性治疗措施对慢性乙型重型肝炎患者的临床影响,为慢性乙型重型肝炎治疗提供参考方向。方法 80例慢性乙型重型肝炎患者随机平分为两组,对照组患者给予基础内科治疗,治疗组在此基础上加用替比夫定或拉米夫定抗病毒治疗,比较两组治疗前后临床症状、生存率、TBil(总胆红素)、PTA(凝血酶原活动度)、ALB(白蛋白)及HBV DNA变化,同时观察不良反应情况。结果经过治疗后,治疗组生存率80.0%,对照组生存率60.0%,治疗组生存率较对照组比较差异有统计学意义(P<0.05)。治疗组治疗4～8周后TBil、ALB及PTA指标改善与对照组比较差异均有统计学意义(P<0.05)。治疗组治疗4—8周后病毒复制得到控制,与对照组血清HBV DNA水平比较差异有统计学意义(P<0.05或P<0.01)。两组不良反应情况对比差异无统计学意义(P>0.05)。结论基于拉米夫定、替比夫定与基础内科治疗联合的系统性治疗措施应用于慢性乙型重型肝炎的治疗可提高生存率,加快肝功能好转及HBV DNA水平下降,值得在临床上进一步研究和推广。
Objective To investigate the clinical effects of systemic treatment on patients with chronic severe hepatitis B and provide reference for the treatment of chronic severe hepatitis B. Methods Eighty patients with chronic severe hepatitis B were randomly divided into two groups. The patients in the control group were given basic medical treatment. The treatment group was treated with telbivudine or lamivudine antiviral therapy. The clinical effects of the two groups were compared before and after treatment Symptom, survival rate, TBil, PTA, ALB and HBV DNA, and observe the adverse reactions. Results After treatment, the survival rate of the treatment group was 80.0% and that of the control group was 60.0%. The survival rate of the treatment group was significantly different from that of the control group (P <0.05). After 4 to 8 weeks of treatment, the improvement of TBil, ALB and PTA in the treatment group was statistically significant compared with the control group (P <0.05). After 4 to 8 weeks of treatment, the virus replication was controlled in the treatment group, which was significantly different from that of the control group (P <0.05 or P <0.01). There was no significant difference in adverse reactions between the two groups (P> 0.05). Conclusion The systematic treatment based on lamivudine combined with telbivudine and basic medical therapy in the treatment of chronic severe hepatitis B can improve the survival rate, speed up the improvement of liver function and decrease of HBV DNA level, and it is worth further clinical study Research and promotion.